Combined vaginal-laparoscopic approach vs. laparoscopy alone for prevention of bladder voiding dysfunction after removal of large rectovaginal endometriosis.

STUDY OBJECTIVE: To assess whether the combined vaginal-laparoscopic route may reduce the risk of postoperative bladder atony, when compared to an exclusively laparoscopic approach, in patients presenting with deeply infiltrating rectovaginal endometriosis with extensive vaginal infiltration. DESIGN: Retrospective comparative cohort study using data prospectively recorded in the CIRENDO database. SETTING: Academic Tertiary Care Centre. PATIENTS: One hundred and thirty-two consecutive patients who underwent surgery of rectovaginal endometriosis with vaginal infiltration measuring greater than 3cm diameter. INTERVENTIONS: Combined vaginal-laparoscopic versus laparoscopic approach. MEASUREMENT AND MAIN RESULTS: Sixty-two patients underwent excision of endometriosis via a combined vaginal-laparoscopic approach (study group, or cases), while 71 patients underwent surgery via an exclusively laparoscopic route (controls). Rates of preoperative cyclical voiding difficulty and sensation of incomplete bladder emptying were comparable between the two groups. Preoperative urodynamic assessment was carried out in 18% of cases and 38% of controls, with abnormal results in 27.3% and 11.1% of cases and controls respectively. Early postoperative voiding difficulty (post-void residual>100mL) occurred in 14.7% and 24.3% of cases and controls respectively. There was a significant reduction in risk of intermittent self-catheterisation of 13% at time of discharge in the study cases. Three months postoperatively, one case and 6 controls had persistent voiding dysfunction requiring prolonged self-catheterisation. CONCLUSION: The combined vaginal-laparoscopic approach for large rectovaginal endometriotic nodules could reduce the risk of postoperative bladder dysfunction, when compared to an exclusively laparoscopic approach, most likely due to a reduced risk of damage to the pelvic splanchnic nerves at the paravaginal level.

Is there a fetal effect with low to moderate alcohol use before or during pregnancy?

STUDY OBJECTIVE: The aim was to investigate the effect of low or moderate alcohol consumption upon fetal outcome. DESIGN: This was a prospective randomised cohort study with mother and infant follow-up sample stratified on level of maternal alcohol intake. SETTING: A large maternity hospital in Western Australia. PARTICIPANTS: 2002 randomly selected pregnant women were recruited over a 3 year period for questionnaire survey (19 mothers refused participation). From 665 women in a stratified subsample selected on the basis of prepregnancy alcohol consumption, 605 newborns were available for study. INVESTIGATION AND MAIN RESULTS: All 2002 women completed a comprehensive questionnaire on demographic, lifestyle (including diet), health, and obstetric factors. Of the 665 mothers who were followed through pregnancy, 605 liveborns were available at birth for measurement and detailed clinical evaluation. Low to moderate prepregnancy maternal alcohol intake was not associated with any untoward effect upon weight, length, head circumference at birth, or clinical well-being as indicated by Apgar score, respiratory distress syndrome, and overall clinical state. Other factors, particularly nicotine, were of much greater importance. CONCLUSIONS: This study fails to show any significant relationship between low to moderate prepregnancy maternal alcohol intake and newborn clinical status. The outcome suggests that cautionary advice to pregnant women warning that any alcohol taken during pregnancy is potentially harmful to the fetus is inaccurate and therefore probably counterproductive.

Confounding variables in studying the effects of maternal alcohol consumption before and during pregnancy.

STUDY OBJECTIVE: to investigate the relationship between alcohol consumption and pregnancy outcome. DESIGN: prospective randomised cohort survey with follow up sample stratified on level of alcohol intake. SETTING: antenatal clinic of large maternity hospital in Western Australia. PARTICIPANTS: 2002 randomly selected pregnant women recruited over 3 year period for questionnaire survey (58% in 1st trimester, 33% in 2nd trimester, 8% in third trimester at recruitment). Only 19 refused participation. Stratified subsample of 665 women followed up, of whom 60 had miscarriage, stillbirth or neonatal death. Subsample was selected on basis of prepregnancy alcohol consumption. INVESTIGATIONS AND MAIN RESULTS: All 2002 women completed a comprehensive questionnaire on demographic, lifestyle, health (including diet) and obstetric factors. The stratified subsample was followed through pregnancy and data were collected on obstetric course and infant outcome. Results showed that beer, wine and spirits drinkers differed significantly in maternal characteristics, nutrition and other important variables such as smoking. Women with stillbirths or miscarriages drank more beer than those with live births, though total levels of alcohol intake did not differ. Beer drinkers were less likely to reduce their consumption in pregnancy than other drinkers if they also smoked more than 20 cigarettes per day. CONCLUSIONS: Studies of effects of maternal drinking must include extensive information on the variables examined in this study or conclusions relating to maternal drinking in pregnancy are likely to be invalid.

Low to moderate maternal alcohol use before and during pregnancy, and neurobehavioural outcome in the newborn infant.

Of 2002 randomly selected pregnant women recruited prospectively over a three-year period for an extensive questionnaire survey, a stratified subsample of 665 mothers was selected for mother-infant follow-up on the basis of pre-pregnancy alcohol intake. Infant outcome was assessed by detailed clinical examination and application of a modified Einstein Neonatal Behavioural Assessment Schedule (ENBAS) performed at 24 to 72 hours of age. Of the infant responses to 25 ENBAS items, only tonus showed a small but significant relationship to pre-pregnancy maternal alcohol intake. The authors conclude that low to moderate maternal alcohol intake has no significant effect on newborn neurological status.