American Journal of Obstetrics and Gynecology

BACKGROUND: The use of polypropylene prolapse mesh to treat pelvic organ prolapse has been limited by mesh-related complications. Gynemesh PS mesh, implanted via sacrocolpopexy in rhesus macaques, negatively impacted vagina with thinning of vaginal muscularis and decreased vaginal smooth muscle contractility. The negative effect was attenuated when a bioscaffold derived from urinary bladder extracellular matrix (ECM) was used as a composite with Gynemesh PS. OBJECTIVE: To further elucidate the impact of Gynemesh PS polypropylene mesh and MatriStem ECM bioscaffolds on the vaginal smooth muscle in terms of micro-morphology of vaginal smooth muscle (muscle bundles and individual myocytes), innervation and nerve-mediated contractile function following their implantations in a rhesus macaque model via sacrocolpopexy...

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No abstract text is available yet for this article.

BACKGROUND: Systematic paraaortic and bilateral pelvic lymphadenectomy is the standard of a comprehensive surgical staging in presumed early epithelial ovarian cancer but no prospective randomized evidence suggests a possible therapeutic value. Moreover, this procedure is associated with potential severe morbidity. The SEntineL LYmph Nodes in early-stage ovarian cancer (SELLY) trial is a prospective study designed to test whether sentinel node detection can accurately predict nodal status in a cohort of women with early EOC...

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OBJECTIVE: Robotic assistance may facilitate completion of minimally invasive hysterectomy, which is the standard of care for the treatment of early-stage endometrial cancer, in patients for whom conventional laparoscopy is challenging. The aim of this systematic review was to assess conversion to laparotomy and perioperative complications after laparoscopic (LH) and robotic hysterectomy (RH) in endometrial cancer patients with obesity (body mass index, BMI>30kg/m2 ). DATA SOURCES: & Eligibility Criteria: We systematically searched MEDLINE, EMBASE, and Evidence-Based Medicine Reviews (January 1, 2000 to July 18, 2018) for studies of patients with endometrial cancer and obesity (BMI>30kg/m2 ) undergoing primary hysterectomy...

BACKGROUND: Complete surgical resection affords the best prognosis at the time of interval debulking surgery. When complete surgical resection is unachievable, optimal residual disease is considered the next best alternative. Despite contradicting evidence on the survival benefit of interval debulking surgery if macroscopic residual disease remains, the current definition of "optimal" in patients undergoing interval debulking surgery is defined as largest diameter of disease measuring ≤1...

BACKGROUND: Same day discharge is becoming increasingly common for women who undergo minimally invasive hysterectomy. For women with endometrial cancer, there is limited data to describe the safety of same day discharge. OBJECTIVE: To examine trends and outcomes of same day discharge for women with endometrial cancer who underwent minimally invasive hysterectomy. STUDY DESIGN: The National Surgical Quality Improvement Program database was used to identify patients who underwent MIS hysterectomy based for endometrial cancer from 2011-2016...

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BACKGROUND: Cervical ripening is commonly needed for labor induction. Finding an optimal route of misoprostol dosing for efficacy, safety, and patient satisfaction is important and not well studied for the buccal route. OBJECTIVE: To compare the efficacy and safety of vaginal and buccal misoprostol for women undergoing labor induction at term. STUDY DESIGN: The IMPROVE trial was an IRB-approved, triple-masked, placebo-controlled randomized non-inferiority trial for women undergoing labor induction at term with a Bishop's Score ≤ 6...

BACKGROUND: Minimally invasive hysterectomy is the standard of care in the majority of women diagnosed with endometrial cancer via robotic-assisted (RL), multi-port (MPL) and single-port laparoscopy (SPL) technology. While safe and efficacious, it is unclear how oncologic outcomes are impacted by surgical platform. OBJECTIVE(S): To identify differences in progression free survival and overall survival in women undergoing minimally invasive surgery for endometrial cancer staging via either MPL, SPL or RL...

BACKGROUND: Smartphones have recently been applied in the medical setting. However, the literature evaluating the utility of smartphones in gynecologic oncology is limited. OBJECTIVES: The objectives of the current study were to evaluate the utility of a smartphone in the detection of uterine cervical lesions in patients with abnormal cervical cytology. STUDY DESIGN: Seventy-five women with abnormal cervical cytology were enrolled. Two doctors independently inspected the uterine cervix by using smartphone or colposcopy...

BACKGROUND: Disease relapse is the primary cause death from ovarian carcinoma (OC). Isolated lymph node relapse (ILNR) is a rare pattern of OC recurrence, with a reported median post-relapse survival (PRS) of 2.5-4 years. To date, investigations have not compared ILNR OC directly to a matched extra-nodal relapse (ENR) cohort or performed molecular characterization of cases that subsequently experience ILNR. OBJECTIVE(S): Here we seek to compare the clinical outcome, tumour-infiltrating lymphocyte burden and frequency of known prognostic genomic events in ILNR OC versus ENR OC...

Despite persistent concerns about high cesarean delivery rates internationally, there has been less attention on improving perioperative outcomes for the millions of women who will experience a cesarean delivery each year. Enhanced Recovery After Surgery (ERAS), a standardized, evidence-based, interdisciplinary protocol, has been successfully used in other surgical specialties including gynecology to improve quality of care and patient satisfaction, while reducing overall healthcare costs through reduced length of stay...

BACKGROUND: Empiric therapy for urinary tract infection is difficult in postmenopausal women due to higher rates of confounding lower urinary tract symptoms and differential resistance profiles of uropathogens in this population. OBJECTIVE: To determine the least costly strategy for treatment of postmenopausal women with the primary complaint of dysuria. STUDY DESIGN: We performed a cost minimization analysis modeling the following clinical options: (1) empiric antibiotic therapy followed by urine culture, (2) urinalysis with empiric antibiotic therapy only if positive nitrites and leukocyte esterase, or (3) waiting for culture prior to initiating antibiotics...

BACKGROUND: Numerous reports have documented bacteria in the placental membranes and basal plate decidua in the absence of immunopathology using histological techniques. Similarly, independent metagenomic characterizations have identified an altered taxonomical makeup in association with spontaneous preterm birth (PTB). Here we sought to corroborate these findings by localizing presumptive intact bacteria using molecular histology within the placental microanatomy. OBJECTIVES: Here we examined for microbes in term and preterm gestations using a signal amplified 16S universal in situ hybridization (ISH) probe set for bacterial rRNA, alongside traditional histologic methods of Warthin-Starry and Gram stains, as well as clinical culture methodologies...

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BACKGROUND: Giving birth in a healthcare facility does not guarantee high-quality care or favorable outcomes. The "working-hour phenomenon" describes adverse outcomes of institutional births outside regular working hours. OBJECTIVES: To evaluate whether the time of birth is associated with adverse neonatal outcomes and to identify the riskiest time periods for obstetrical care. STUDY DESIGN: This nationwide retrospective cohort study analyzed data from 2008 to 2016 from all 82 obstetric departments in Austria...

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BACKGROUND: The benefit of aspirin in preventing preeclampsia is well established, however, studies over the years have demonstrated variability in outcomes with its use. Potential contributing factors to this variation in efficacy include dosing, time of dosing and preparation of aspirin OBJECTIVE(S): We aimed to compare the difference in pharmacokinetics of aspirin, through its major active metabolite, salicylic acid (SA), in pregnant women to non-pregnant women and examine the effect of dose (100mg vs 150mg), preparation (enteric coated (EC) vs non-EC) and chronotherapy of aspirin (morning vs night) between both groups...