American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Feb 2015
Comparative Study Clinical TrialA prospective comparison of postoperative pain and quality of life in robotic assisted vs conventional laparoscopic gynecologic surgery.
We sought to compare robotic vs laparoscopic surgery in regards to patient reported postoperative pain and quality of life. ⋯ Our results demonstrate no difference in postoperative pain between conventional laparoscopy and robotic assisted surgery for gynecologic procedures. Furthermore, pain did not appear to interfere consistently with any daily activity of living. Interference of sleep needs to be further evaluated after controlling for bilateral salpingo-oophorectomy.
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Am. J. Obstet. Gynecol. · Feb 2015
Maternal morbidity in patients with morbidly adherent placenta treated with and without a standardized multidisciplinary approach.
The purpose of this study was to test the hypothesis that a standardized multidisciplinary treatment approach in patients with morbidly adherent placenta, which includes accreta, increta, and percreta, is associated with less maternal morbidity than when such an approach is not used (nonmultidisciplinary approach). ⋯ The institution of a standardized approach for patients with morbidly adherent placentation by a specific multidisciplinary team was associated with improved maternal outcomes, particularly in cases with more aggressive placental invasion (increta or percreta), compared with a historic nonmultidisciplinary approach. Our standardized approach was associated with fewer emergency deliveries.
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Am. J. Obstet. Gynecol. · Feb 2015
Is universal cervical length screening indicated in women with prior term birth?
To determine whether universal transvaginal ultrasound (TVU) cervical length (CL) screening is indicated in women with prior term births. ⋯ Women with prior term birth have a trend toward a lower incidence of CL ≤20 mm, compared with nulliparous women. Further studies are needed to determine whether women with prior term births should be included or excluded from TVU CL screening.
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Am. J. Obstet. Gynecol. · Feb 2015
Impact of prolapse meshes on the metabolism of vaginal extracellular matrix in rhesus macaque.
The impact of polypropylene mesh implantation on vaginal collagen and elastin metabolism was analyzed using a nonhuman primate model to further delineate the mechanism of mesh induced complications. ⋯ Following implantation with the heavier, less porous, and stiffer mesh, Gynemesh PS, the degradation of vaginal collagen and elastin exceeded synthesis, most likely as a result of increased activity of MMPs, resulting in a structurally compromised tissue.
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Am. J. Obstet. Gynecol. · Feb 2015
Randomized Controlled Trial Comparative StudyRandomized controlled double-blind trial of transversus abdominis plane block versus trocar site infiltration in gynecologic laparoscopy.
The objective of the study was to determine whether transversus abdominis plane (TAP) block reduces postoperative pain when compared with trocar site infiltration of bupivacaine in gynecological laparoscopy. ⋯ As part of this multimodal analgesic regimen, neither block method provided a significant clinical benefit compared with trocar site bupivacaine infiltration.