Single incision sacrospinous hysteropexy combined with cystopexy (SISHC): a suitable mini-invasive approach for pelvic organ prolapse in post menopausal women

Abstract

Aim:To assess if fetal fibronectin testing is being performed on the correct patients and how the results of this test is impacting on our management of patients presenting with threatened preterm labour.Method: Retrospective review of 33 charts where a fetal fibronectin test would have been deemed appropriate.Main results: The gestational age ranged from 24 + 3 weeks to 35 + 6 weeks gestation. Patients presented with abdominal pain, tightenings, contractions or backache. All patients were assessed by midwifery and medical staff and of the 33 patients who met the criteria for fetal fibronectin testing, 30 patients has the test. Of the 3 who did not have the test, one discharged herself from hospital before the test could be preformed, 1 patient had a recent negative result and 1 patient was clinically assessed and the test felt not to be appropriate. There were 4 positive results and 26 negative results. All 4 patients with positive results were admitted to hospital with one of those being transferred to another hospital as no cot was available in Antrim Area Hospital. 3 out of the 4 patients had steroids and tocolysis. The 4th patient had recently completed a course of steroids. There was a 50% admission rate for those with a negative result and 15% of those were given steroids. 15% of those admitted with a negative result were treated for a urinary tract infection. There were 6 deliveries before 37 weeks. 4 of these patients had tested negative and 2 had a positive fetal fibronectin test. The earliest delivery was at 34 + 3 weeks, having had a positive fetal fibronectin test at 32 + 3 weeks. The latest delivery was at 36 + 2 weeks, having had a positive fetal fibronectin test at 29 + 6 weeks. Of the 4 patients who delivered with a negative fetal fibronectin test, the gestation ranged from 35 + 5 to 36 + 2 weeks. 2 had spontaneous onset of labour, 1 was induced and 1 had an emergency C/Section for scar pain. All deliveries were in Antrim Area Hospital.Conclusion: Fetal fibronectin can be a useful test if used appropriately. A positive test cannot tell us when labour will occur but allows us to treat these patients as high risk and administer steroids and tocolytics. This was the cases with our patients who had a positive test. A negative result can provide reassurance that preterm labour is unlikely in the next 7-10 days. However in our review we found that 50% patients with a negative test were still being admitted and 15% of these received steroids. Overall management of those with a positive test was excellent but we need to manage those with a negative test better. Current management has financial consequences with possible un-necessary admissions plus timing of steroid administration may not be optimal.http://dx.(O. Ami).Purpose: 3D reconstruction of birthcanal and fetus was obtained from imaging performed with 1 T open field MRI before and during childbirth on 10 patients. Fetal head molding and birthcanal changes are fully described in 3D vectorial meshes.Method and materials: 10 women were enrolled in th...