Face presentation at term: incidence, risk factors and influence on maternal and neonatal outcomes.

OBJECTIVES: The incidence, diagnosis, management and outcome of face presentation at term were analysed. METHODS: A retrospective, gestational age-matched case-control study including 27 singletons with face presentation at term was conducted between April 2006 and February 2021. For each case, four women who had the same gestational age and delivered in the same month with vertex position and singletons were selected as the controls (control group, n = 108). Conditional logistic regression was used to assess the risk factors of face presentation. The maternal and neonatal outcomes of the face presentation group were followed up. RESULTS: The incidence of face presentation at term was 0.14‰. After conditional logistic regression, the two factors associated with face presentation were high parity (adjusted odds ratio [aOR] 2.76, 95% CI 1.19-6.39)] and amniotic fluid index > 18 cm (aOR 2.60, 95% CI 1.08-6.27). Among the 27 cases, the diagnosis was made before the onset of labor, during the latent phase of labor, during the active phase of labor, and during the cesarean section in 3.7% (1/27), 40.7% (11/27), 11.1% (3/27) and 44.4% (12/27) of cases, respectively. In one case of cervical dilation with a diameter of 5 cm, we innovatively used a vaginal speculum for rapid diagnosis of face presentation. The rate of cesarean section and postpartum haemorrhage ≥ 500 ml in the face presentation group was higher than that of the control group (88.9% vs. 13.9%, P < 0.001, and 14.8% vs. 2.8%, P = 0.024), but the Apgar scores were similar in both sets of newborns. Among the 27 cases of face presentation, there were three cases of adverse maternal and neonatal outcomes, including one case of neonatal right brachial plexus injury and two cases of severe laceration of the lower segment of the uterus with postpartum haemorrhage ≥ 1000 ml. CONCLUSIONS: Face presentation was rare. Early diagnosis is difficult, and thus easily neglected. High parity and amniotic fluid index > 18 cm are risk factors for face presentation. An early diagnosis and proper management of face presentation could lead to good maternal and neonatal outcomes.

Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single-center study with low perioperative complications.

Sacrospinous ligament fixation (SSLF) is one of the most used native tissue approaches for apical suspension with a high rate of perioperative complications. This study aimed to review cases undergoing a modified SSLF and assess its perioperative adverse events. It was a retrospective study of 168 consecutive patients undergoing modified transvaginal SSLF at a single tertiary center from 2017 to 2021. The sutures were placed on the sacrospinous ligament (SSL) approaching the sacrum through natural spaces under direct vision. Moreover, it was performed bilaterally. Patient demographics and perioperative complications were reviewed. The median age was 65 years, and 85.7% (144/168) had stage III-IV prolapse. Among the 168 patients undergoing this modified SSLF, 161 were for uterovaginal prolapse, and seven were for posthysterectomy vaginal vault prolapse. 83.9% (135/161) patients were concomitant with hysterectomy, and 70.2% (118/168) were with anteroposterior colporrhaphy. The median operation time was 82 min (interquartile range [IQR], 61-100 min), and the median intraoperative blood loss was 50 ml (IQR, 30-50 ml). Two cases had pelvic hematoma, and both were cured after expectant treatment. No patient required a homologous blood transfusion, and none complained about buttock or lower limb pain 2 weeks postoperatively. Nor did injury of the ureters, bladder, or rectum occur intraoperatively. This modified transvaginal SSLF procedure was safe and had no severe perioperative complications.

Anatomic identification of laparoscopic uterosacral ligament suspension: A step-by-step procedure.

INTRODUCTION AND HYPOSTHESIS: The uterosacral ligament (USL) is the main structure of physiological apical support, and USL suspension is one of the most commonly used methods for native tissue apical suspension. Structures surrounding the USL are complex, and the USL itself is difficult to identify, especially the sacral portion of the USL. Laparoscopy improves visualization, but exposure of the USL is still unsatisfactory. METHODS: In this study, we report a simple method for exposing and suturing the USL laparoscopically, with step-by-step instructions, well-presented figures and videos. The key techniques are shown as follows: keeping tension on the USL with a uterine manipulator, dissecting the space medial to the USL, exposing the portion of the USL near the sacrum through the natural space, and then suturing it medially and connecting it directly to the posterior cervix. RESULTS: 95 consecutive patients have undergone this modified USLS and none had serious perioperative complication. CONCLUSION: In this way, the USL anatomy is exposed well, which may make placement of sutures in USL suspension safe and effective.

Curative effect of kangfuyan capsule combined with antibiotic treatment on pelvic inflammatory disease.

This study aims to investigate the curative effect of Kangfuyan capsule in the treatment of damp-heat and blood stasis type of pelvic inflammatory disease (PID), and its influence on serum inflammatory factors IL-6, CRP and TNF-α. A total of 83 patients with PID were randomly divided into two groups: Western medicine group (control group, n=41) received oral antibiotics (azithromycin + metronidazole) alone and the traditional Chinese medicine combined with Western medicine group (experimental group, n=42) received Kangfuyan capsule based on Western medicine therapy. Clinical efficacy between these two groups and the influence of drugs in serum inflammatory factors (IL-6, CRP and TNF-α) were compared. The total effective rate was 78.05% in the control group and 97.62% in the experimental group and difference between these two groups was statistically significant (P<0.01). The symptoms and signs in the two groups significantly improved after treatment (P<0.05) and improvement rate was significantly better in the experimental group than in the control group (P<0.05). After treatment, serum inflammatory factor levels in the two groups were significantly lower than levels before treatment (P<0.05) and improvement rate was significantly better in the experimental group than in the control group (P<0.05). Kangfuyan capsule combined with antibiotics can effectively relieve the symptoms and signs of patients, improve the efficiency of treatment, provide high safety, and does not increase adverse reactions. The possible mechanism may be that this therapy suppresses chronic PID by reducing serum inflammatory factor (IL-6, CRP and TNF-α) levels.

VEGF and bFGF increase survival of xenografted human ovarian tissue in an experimental rabbit model.

PURPOSE: The aim of this study is to determine whether vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) could increase the survival of xenografted human ovarian tissue in an experimental rabbit model. METHODS: Fresh human ovarian tissue was xenotransplanted into the back muscle of 25 castrated female New Zealand rabbits for 6 weeks with the immunosuppression of FTY720 (2 mg/kg/d). Rabbits were randomly divided into five experimental groups: (A) graft and host treatment with VEGF (50 ng/ml); (B) graft and host treatment with bFGF (100 ng/ml); (C) graft and host treatment with VEGF(50 ng/ml) + bFGF (100 ng/ml); (D) graft and host treatment with normal saline; (E) control group, no treatment. 4 weeks after transplantation, human menopausal gonadotropin (HMG) 10 IU was administered every second day in group A, group B, group C and group D for 2 weeks. Graft survival was assessed by graft recovery rate, histological analysis, immunohistochemical staining for CD31 and Ki-67expression, TUNEL assay. RESULTS: After 6 weeks of grafting, the number of CD31-positive stained cells increased significantly in group A, group B and group C compared to the control group. All groups showed strong Ki-67 immunostaining in ovarian stroma. Only one rabbit in group C retained the grafts' follicles. Grafting resulted in relative lower fibrosis in group A and group C compared to the control group. Apoptosis was significantly lower in group C compared to the control group. CONCLUSIONS: Fresh human ovarian cortex grafted into the back muscle of rabbit can sustain part of ovarian tissue function with the immunosuppression of FTY720, although follicle number diminishes significantly after grafting. The administration of VEGF and bFGF, especially the combination of them, may trigger angiogenesis, reduce apoptosis and fibrosis, increase survival in transplanted human ovarian tissue.

FTY720 and cyclosporin protect ovarian tissue grafted into rabbits.

OBJECTIVE: To determine whether FTY720 combined with CsA has immunomodulatory effects on human ovarian tissue transplanted to the back muscle of rabbits for an 8-week period. STUDY DESIGN: We selected rabbits as recipients of ovarian xenografts with and without treatment by CsA and FTY720. Ovarian fragments from twelve patients were cut into 2 mm × 2 mm, 1-2mm thick pieces and randomly distributed into four groups: Group 1 (FTY720 2 mg/kg/d+CsA 3 mg/kg/d), Group 2 (FTY720 1 mg/kg/d+CsA 3mg/kg/d), Group 3 (FTY720 0.5 mg/kg/d+CsA 3mg/kg/d) and Group 4 for control (CsA 3 mg/kg/d). FTY720 was started three days before transplantation and was given daily after transplantation. CsA was administrated post-transplantation. All the animals were killed 8 weeks post- transplantation. Levels of serum estrogen (E2), interferon-γ (IFN-γ) and interleukin-4 (IL-4) were detected by radioimmunoassay and ELISA. Anti-CD31 and anti-Ki-67 antibodies were used to evaluate neo-vascularization in xenografts and proliferation activity of ovarian follicles. Peripheral CD4+/CD8+ T cells were analyzed by flow cytometry. RESULTS: Combined treatment with cyclosporin A and FTY720 improved graft survival and reduced peripheral CD4+ and CD8+ T cell counts compared to treatment with cyclosporin A alone. Neovascularization took place in the peripheral zone of the xenograft while granulosa cells, positively stained by Ki-67, were found in early-stage follicles and stromal cells in the combined treatment groups. CONCLUSION: FTY720 in combination with cyclosporin A maintains human ovarian xenografts in these rabbit models.