BackgroundStudies have shown that vaginal vault prolapse can affect up to 43% of women following hysterectomy for pelvic organ prolapse. Many techniques have been described to prevent and treat vaginal vault prolapse. The primary objective of our study was to compare McCall’s culdoplasty (when performed along side vaginal hysterectomy) with laparoscopic uterosacral plication (when performed along side total laparoscopic hysterectomy) for prevention of vaginal vault prolapse. Secondary outcomes included inpatient stay and perioperative complications.A retrospective comparison study comparing 73 patients who underwent ‘laparoscopic hysterectomy and uterosacral plication’ against 70 patients who underwent ‘vaginal hysterectomy and McCall culdoplasty’. All operations were carried out by two trained surgeons.ResultsThere was no significant difference between BMI or parity. There were statistically significantly more patients presenting with post hysterectomy vault prolapse (PHVP) in the group of patients who had undergone uterosacral plication (12 out of 73) compared with McCalls culdoplasty (0 out of 70) P = 0.000394. Inpatient stay in the uterosacral plication group was significantly shorter mean 1.8 compared to 3.6 for McCall group (P-Value is <0.00001). There was no significance in the perioperative complications between both groups (P = 0.41).ConclusionsMcCalls is a superior operation to prevent PHVP compared to uterosacral plication with no difference in terms of perioperative complications.

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The purpose of this study is to compare success rate, patient satisfaction, discomfort, procedure time and intraoperative adverse events of hysteroscopic (Essure®) versus laparoscopic sterilisation. This study includes a retrospective case-control comparative study of 70 patients who had laparoscopic or hysteroscopic sterilisation performed. Systematic chart review for the documentation of preoperative counselling, operative time, intraoperative complications, documentation of correct application of Essure® and Filshie® clips and duration of hospital stay was also done. Patient follow-up was arranged and a questionnaire completed including details of postoperative pain, satisfaction of procedure, recovery time and compliance with confirmatory hysterosalpingogram attendance and associated pain. The main outcome measures were pregnancy rate following attempted tubal blockage, return to normal activity and patient satisfaction. Secondary outcome measures include patient discomfort, procedure time, device placement, compliance with hysterosalpingogram, postoperative complications and recovery time. There is a statistical difference in favour of Essure® for postoperative pain, operative time, return to work/normal activity and hospital stay with no difference in complications or pregnancy. As a conclusion, Essure® is a safe and effective alternative to laparoscopic sterilisation with significantly less procedurerelated pain.

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Objectives: (1) To investigate the proportion of primiparous women in our unit with a BMI ≥30 during pregnancy and compare their outcomes to those with a BMI <30. (2) To audit our compliance with local trust and RCOG guidelines on the management of obesity during pregnancy. Methods: We carried out a retrospective audit over 6 months from January to June 2015. We obtained data for 100 of the 129 primiparous women with a BMI ≥30 who delivered in our unit during this period. We reviewed their maternity notes and completed a standard proforma for each patient. We also used data from our Northern Ireland Maternity System to compare outcomes with primiparous women with a BMI <30 delivering in our unit during this time period. Results: The proportion of primiparous women with a BMI ≥30 delivering during this period was 18.7% (n = 129). The results demonstrated in the graph above, show increased rates of PIH and GDM in women with BMI ≥35, consistent with rates reported in the literature. Furthermore, 22% and 17% of women with a BMI ≥35 were induced due to gestational diabetes and PIH respectively, compared to 6% for each indication in women with a BMI <30. There was also a high rate (20%) of postnatal infection in women with BMI ≥40. Ultrasound is another challenge in women with obesity and we found 22% of women BMI ≥35 had an anomaly scan 20 weeks which was documented as technically difficult due to body habitus. In assessment of our compliance with trust and RCOG guidance, we found high rates of appropriate risk assessment for thromboembolism and diabetes. However, only 8% of women with a BMI ≥35 received low dose aspirin, 18% of women received high dose folic acid, and 51% received vitamin D during pregnancy. Our trust also has a policy of informing women of the risks of obesity by providing patient information leaflets 'being overweight and pregnant'. This was only recorded as given to 1% of women. Conclusion: This audit highlights the burden that maternal obesity places on the healthcare system in our local context. It is clear that we need to ensure both staff and women understand the risks of obesity during pregnancy. To improve patient education we will design a poster that clearly shows the adverse outcomes associated with increased BMI in our unit, and display it in the waiting area of the maternity outpatient department. A public health initiative "weigh to a healthy pregnancy" has already been initiated to provide these women with midwifery and dietetic support to manage their weight and lifestyle. We will educate both community and hospital staff by presenting our audit results and by providing an update on the guidelines. As a result we hope improve the numbers of these women that receive high dose folic acid and low dose aspirin where appropriate. Lastly, we plan to introduce a checklist to remind staff in clinics to complete the full bundle of care for women with BMI ≥35 at their booking appointment.