Introduction and hypothesis
We studied the geometry of and changes in structures that play an important role in stabilizing the pelvic system during pregnancy using a numerical system at different ...gestational ages and postpartum.
Methods
We developed a parturient numerical model to assess pelvic structures at different gestational stages (16, 32, and 38 weeks) and postpartum (2 months and 1 year) using magnetic resonance imaging (MRI). Organs, muscles, and ligaments were segmented to generate a 3D model of the pelvis. We studied changes in the length of uterosacral ligaments (USL) and thickness of the puborectal portion of the levator ani muscle (LAM) during and after pregnancy. We used this model to perform finite element (FE) simulation and analyze deformations of these structures under stress from the increase in uterine weight.
Results
Analysis reveals an increase in the length of US ligaments at 16, 32, and 38 weeks. Two months after delivery, it decreases without returning to the length at 16 weeks of pregnancy. Similar changes were observed for the puborectal portion of the LAM. Variations observed in these structures are not equivalent to other anatomical structures of pelvic suspension. FE simulation with increased uterus weight does not lead to those findings.
Conclusion
This analysis brings new elements and a new focus for discussion relating to changes in pelvic balance of parturient women that are not simply linked to the increase in uterine volume.
Polypropylene meshes have specific complications, and in 2016 the Food and Drug Administration required a Premarket Approval for their use in pelvic prolapse repair, as there was a lack of long-term ...data.
Our objectives were to determine the long-term reoperation rates and type in our patients after transvaginal mesh repair and to study their risk factors.
We were able to follow up with 349 patients from a single University Hospital, with phone calls, after a median time of 8,5 years.
The 8.5-year reoperation rates were derived from Kaplan-Meier survival curves.
Our global, long-term reoperation rate, including mesh complications, prolapse recurrence and urinary incontinence after a median follow-up of 8.5 years, was 14.5%.
The mesh-related complication rate (including mesh exposures, infections, and retractions requiring surgery) was 4.3%, the urinary incontinence rate was 5.7%.
The prolapse recurrence rate was 7.2%; mainly found with posterior mesh only (18.5% of reoperations).
For total Prolift, the reoperation rate for prolapse recurrence was only 4%. Moreover, 867% of the patients who had an anterior Prolift only or a posterior Prolift only and who were re-operated for prolapse recurrence showed recurrence exclusively in another compartment. In bivariate analysis, only the posterior mesh type was significantly associated with prolapse recurrence versus total meshes.
Despite their market withdrawal, the transvaginal meshes are a safe and efficient option for pelvic organ prolapse surgical management. Low rates of mesh complications can be achieved with cautious dissection and adequate training of surgeons.
Red blood cell (RBC) transfusion remains a critical component in caring for the acute and chronic complications of sickle cell disease (SCD). Patient alloimmunisation is the main limitation of ...transfusion, which can worsen anaemia and lead to delayed haemolytic transfusion reaction or transfusion deadlock. Although biological risk factors have been identified for immunisation, patient alloimmunisation remains difficult to predict. We aimed to characterise genetic alloimmunisation factors to optimise the management of blood products compatible with extended antigen matching to ensure the self-sufficiency of labile blood products. Considering alloimmunisation in other clinical settings, like pregnancy and transplantation, many studies have shown that HLA Ib molecules (HLA-G, -E, and -F) are involved in tolerance mechanism; these molecules are ligands of immune effector cell receptors (LILRB1, LILRB2, and KIR3DS1). Genetic polymorphisms of these ligands and receptors have been linked to their expression levels and their influence on inflammatory and immune response modulation. Our hypothesis was that polymorphisms of HLA Ib genes and of their receptors are associated with alloimmunisation susceptibility in SCD patients. The alloimmunisation profile of thirty-seven adult SCD patients was analysed according to these genetic polymorphisms and transfusion history. Our results suggest that the alloimmunisation of SCD patients is linked to both HLA-F and LILRB1 genetic polymorphisms located in their regulatory region and associated with their protein expression level.
Purposes
The objective of this study is to design a 3D biomechanical model of the female pelvic system to assess pelvic organ suspension theories and understand cystocele mechanisms.
Methods
A finite ...elements (FE) model was constructed to calculate the impact of suspension structure geometry on cystocele. The sample was a geometric model of a control patient’s pelvic organs. The method used geometric reconstruction, implemented by the biomechanical properties of each anatomic structure. Various geometric configurations were simulated on the FE method to analyse the role of each structure and compare the two main anatomic theories.
Results
The main outcome measure was a 3D biomechanical model of the female pelvic system. The various configurations of bladder displacement simulated mechanisms underlying medial, lateral and apical cystocele. FE simulation revealed that pubocervical fascia is the most influential structure in the onset of median cystocele (essentially after 40 % impairment). Lateral cystocele showed a stronger influence of arcus tendineus fasciae pelvis (ATFP) on vaginal wall displacement under short ATFP lengthening. In apical cystocele, the uterosacral ligament showed greater influence than the cardinal ligament. Suspension system elongation increased displacement by 25 % in each type of cystocele.
Conclusions
A 3D digital model enabled simulations of anatomic structures underlying cystocele to better understand cystocele pathophysiology. The model could be used to predict cystocele surgery results and personalising technique by preoperative simulation.
As endometriosis is not a single condition but different morphological types, it is easy to conceive that its management allow for a diversity of approaches. The objective of this literature review ...is about a simplified pathway through care for patients with endometriosis, and to target the right time for surgical treatment.
Through a literature and references review, the different surgical care arrangements according to attainment, to symptoms and to the patients demands and expectations are reviewed.
An existing literature and recommendations synthesis has been done, and it was found that an optimum medical or surgical care rely on a multidisciplinary approach. Asymptomatic patients should not have surgery, and the medical treatment precede surgical treatment in numerous indications. In case of a surgical need, the right moment is determined by the recommendations, as noted in this article. Different aspects are necessary, the symptomatology, the intend to be pregnant and the recurrence of lesions in particular, but also the use of medically assisted reproduction or not.
In order to optimize the surgical treatment of patients with endometriosis, it is advisable to not refer these patients to the surgeon not too soon and not too late, furthermore if he's an expert. In all cases the treatment is multidisciplinary, and the most difficult cases are referred to multidisciplinary consultative reunion. The surgical treatment relies on "centre of expertise's" existence for some specific forms of deep endometriosis. The surgical treatment is a question of both pathology and timing.
In order to optimize the surgical treatment of endometriosis, it is advisable to refer patients to the surgeon at the right moment.
Complete 3 dimensional reconstruction of parturient pelvic floor Gatellier, Marie-Anne; dit Gautier, Estelle Jean; Mayeur, Olivier ...
Journal of gynecology obstetrics and human reproduction,
January 2020, 2020-Jan, 2020-01-00, 20200101, 2020-01, Volume:
49, Issue:
1
Journal Article
Peer reviewed
Open access
The women pelvic floor is a complex system, which seems to endure several modifications during pregnancy and childbirth. Our primary purpose was to build an extensive 3 dimensional (3D) numerical ...anatomical model of the women pelvic floor.
First, the role and the location of each organ, muscle, or ligament, were identified through an extensive literature review. Then, different entities were selected because of their visibility and importance in the pelvic floor. Each entity was identified using anatomical knowledge, and outlined on 2 dimensional (2D) MRI images, that were carried out on 4 pregnant women, using sequences T1, T2 and proton density weighted, through AVIZO program. The overlay of these 2D outlines produced a 3D geometrical reconstruction, which was then reworked with the program CATIA to obtain a usable geometric model.
We identified and integrated 15 anatomical structures to the geometrical model, including organs, ligament and muscles from the pelvis and perineum. This geometrical model allowed us to obtain a visual interactive representation with 3D images. These different steps resulted in the creation of a complete numerical model of the female pelvic floor, which might be used in Finite Element simulation.
A new complete and accurate 3D numerical anatomical model of the women pelvic floor was elaborated. It presents simultaneously analytical prospects, through the observation of the strains and deformations that are imposed on the different structures, and educational prospects, through the detailed visual representation of several situations.
The emergence of new technologies in the obstetrical field should lead to the development of learning applications, specifically for obstetrical emergencies. Many childbirth simulations have been ...recently developed. However, to date none of them have been integrated into a serious game.
Our objective was to design a new type of immersive serious game, using virtual glasses to facilitate the learning of pregnancy and childbirth pathologies. We have elaborated a new game engine, placing the student in some maternity emergency situations and delivery room simulations.
A gynecologist initially wrote a scenario based on a real clinical situation. He also designed, along with an educational engineer, a tree diagram, which served as a guide for dialogues and actions. A game engine, especially developed for this case, enabled us to connect actions to the graphic universe (fully 3D modeled and based on photographic references). We used the Oculus Rift in order to immerse the player in virtual reality. Each action in the game was linked to a certain number of score points, which could either be positive or negative.
Different pathological pregnancy situations have been targeted and are as follows: care of spontaneous miscarriage, threat of preterm birth, forceps operative delivery for fetal abnormal heart rate, and reduction of a shoulder dystocia. The first phase immerses the learner into an action scene, as a doctor. The second phase ask the student to make a diagnosis. Once the diagnosis is made, different treatments are suggested.
Our serious game offers a new perspective for obstetrical emergency management trainings and provides students with active learning by immersing them into an environment, which recreates all or part of the real obstetrical world of emergency. It is consistent with the latest recommendations, which clarify the importance of simulation in teaching and in ongoing professional development.
Fertiloscopy is as safe as laparoscopy in literature, but we don’t know its relevance in women with unexplained infertility (UI). Our objective was to assess the effects of fertiloscopy procedures on ...the outcomes of subsequent pregnancy occurrences in patients with UI.
Retrospective, single-center study of all patients followed up after fertiloscopy procedures between 2002 and 2007. The occurrence and outcome of pregnancies were studied in the five years following the procedure.
124 fertiloscopies were performed. Pelvic exploration was considered as sufficient in 83.8% of cases, of which no abnormalities were found in 78.2%. Laparoconversions occurred for 19 patients (16.5%). The pregnancy rate at five years was 76.9%. The mean delay for pregnancy occurrence was 10.7 months (±17).
The pregnancy rate in our study is similar to that after laparoscopy. Fertiloscopy, a less intrusive procedure, should be considered as a reliable option for the management of patients with UI.
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