Current Issue : April-June Volume : 2025 Issue Number : 2 Articles : 6 Articles
Background The aim of this study was to assess the learning curve of robotic-assisted sacrocolpopexy by applying CUSUM analysis based on operation time, complication rate and conversion rate to open laparotomy. Methods A retrospective study was conducted with 50 consecutive robotic-assisted sacrocolpopexy surgeries performed from June 2018 and June 2023 by a single experienced gynecologist. Baseline patient demographics, intraoperative parameters and postoperative outcomes were collected. Cumulative sum (CUSUM) of robotic-assisted sacrocolpopexy operation time was analyzed to determine breakpoints between learning phases using piecewise linear regression. This allowed the detection of subtle shifts in surgical parameters and ultimately surgeon proficiency and competency. Continuous variables, such as age, length of hospitalization and op time, were reported as mean (standard deviation). One-way analysis of variance was employed to compare continuous variables. Categorical variables were expressed as percentages and analyzed using the chi-square test. Results The regression identified breakpoints at case 8.47 (95% CI 8.0, 9.0) and case 34.41 (95% CI 32.7, 36.1), with an R2 value of 0.87, which agrees with that of the second-order polynomial equation. The breakpoints were rounded to the next whole number at case 9 and 35. The Learning, Proficiency, and Competency phases consisted of 9, 26, and 15 cases, respectively in this consecutive series. This suggests that the surgeon achieved proficiency after the first 9 cases and competency after 35 cases. There were no intraoperative nor short-term post-operative complications during the span of this study. Furthermore, there were no conversions to open laparotomy. CUSUM analysis based on complication and conversion rate, therefore, was not available. Conclusion According to CUSUM analysis, surgical proficiency of robotic-assisted sacrocolpopexy was attained after the first 9 cases, and stabilization of operation time was achieved after 35 cases. This statistical tool has proven to be useful in objectively assessing learning curves for new surgical techniques, and the transition from laparoscopic sacrocolpopexy to robotic-assisted sacrocolpopexy seems achievable. This, however, may vary with each surgeon’s manual dexterity and experience level. Further investigation with several surgeons and institutions is needed to define a more accurate and generalized learning curve of robotic-assisted sacrocolpopexy....
Background/Objectives: The current trend in maternal health is to foster more natural and less medicalized therapies, with increasing interest in complementary therapies. This study has analyzed the benefits of complementary therapies during pregnancy, delivery and the postpartum period. Methods: A paired systematic review was carried out (PROSPERO: CRD42024543981). The following databases were consulted: PubMed, Scopus,Web of Science and CINAHL. Inclusion criteria were randomized clinical trials about complementary therapies in women during pregnancy, delivery and/or the postpartum period. The risk of bias of the clinical trials was evaluated using the revised Cochrane Risk of Bias tool for randomized trials version 2 (RoB-2). Results: A total of 1684 studies were found, with a final selection of 17. The most studied symptom was pain. Hydrotherapy, perinatal Swiss ball exercises, acupressure, virtual reality and foot reflexology provided a significant reduction in pain during labor. Similarly, aromatherapy, electroacupuncture and massage have shown significant benefits in pain management after Cesarean. Yoga, when practiced during pregnancy, effectively reduces anxiety and depression, with similar benefits observed when practiced during the postpartum period. Conclusions: Complementary therapies improve pain, anxiety and depression management across maternal health phases....
Digital twin technology, originally developed for intricate physical systems, holds great potential in women’s healthcare, particularly in the management of pelvic floor disorders. This paper delves into the development of a digital twin specifically for the female pelvic floor, which can amalgamate various data sources such as imaging, biomechanical assessments, and patient-reported outcomes to offer personalized diagnostic and therapeutic insights. Through the utilization of 3D modeling and machine learning, the digital twin may facilitate precise visualization, prediction, and individualized treatment planning. Nevertheless, it is crucial to address the ethical and practical challenges related to data privacy and ensuring fair access. As this technology progresses, it has the potential to revolutionize gynecological and obstetric care by enhancing diagnostics, customizing treatments, and increasing patient involvement....
Objective: To study the factors associated with oligohydramnios and its related neonatal morbidity and mortality. Materials and Methods: This was a 10-year retrospective nested case-control study conducted at a level 2 maternity ward. Given that the prevalence of oligohydramnios ranges between 0.5% and 8%, the sample size of the cases was calculated using the following formula: n = (z /Δ)2 × p(1 − p). We selected 20 controls for each case. Data were exported to Excel and analyzed using the Statistical Package for Social Sciences (SPSS) and R Studio 4.1.3 software. The maximal deepest pocket of amniotic fluid or the amniotic fluid index was used to establish the diagnosis. Qualitative variables were described as proportions relative to the total. Data were compared using the chi-square test when normality conditions were met or non-parametric tests otherwise. The significance threshold was set at 0.05. Results: Out of a cohort of 56,775 deliveries, we collected 145 cases of oligohydramnios and 2953 controls. The prevalence of preeclampsia was seven times higher in cases of oligohydramnios (OR = 7.7 [5.12; 11.7]). The prevalence of small-for-gestational-age (SGA) fetuses was four times higher in the case group (OR = 4.3 [3.04; 6.21]). Oligohydramnios were associated with an increased risk of labor artificial induction and cesarean sections respectively 4.51 ([2.95; 6.99]) and 3.41 ([3.03; 3.78]). Perinatal asphyxia was nearly three times more frequent in children born in the context of oligohydramnios (OR = 2.7 [1.38; 5.30]). Vaginal delivery and SGA were not associated with neonatal morbidity or mortality in cases of oligohydramnios. Conclusion: Oligohydramnios is associated with obstetric pathologies and increased neonatal morbidity and mortality. However, vaginal delivery and labor induction do not impact neonatal morbidity and mortality. The risk of perinatal asphyxia in oligohydramnios requires special monitoring in the delivery room. Further studies on the relationship between fetal heart patterns during and asphyxia in oligohydramnios will need to be conducted....
Abdominal pregnancy is a rare ectopic pregnancy in which the trophoblast implants in the peritoneal cavity. Diagnosis and management are difficult. We report the case of a 21-year-old primigravida, who consulted the hospital in Ségou for an abdominal pregnancy that had stopped at around 16 weeks. We performed a laparotomy and removed a gestational sac included in the left broad ligament containing a still-macerated female foetus weighing 145 g after a second ultrasound following the failure of induction with misoprostol for 48 hours. This case highlights the difficulty of diagnosing abdominal pregnancy in our environment despite the more frequent use of ultrasound....
Our primary objective was to assess the effectiveness of detailed cardiovascular ultrasound screening during the first trimester, which was performed by obstetricians with intermediate experience. We collected first-trimester fetal cardiac screening data from an unselected pregnant population at RMC-Fetal Medicine Center during a study period spanning from 1 January 2010, to 31 January 2015, in order to analyze our learning curve. A pediatric cardiologist performed a follow-up assessment in cases where the examining obstetrician determined that the fetal cardiac screening results were abnormal or high-risk. Overall, 42 (0.88%) congenital heart abnormalities were discovered prenatally out of 4769 fetuses from 4602 pregnant women who had at least one first-trimester cardiac ultrasonography screening. In total, 89.2% of the major congenital heart abnormalities (27 of 28) in the following fetuses were discovered (or at least highly suspected) at the first-trimester screening and subsequent fetal echocardiography by the pediatric cardiology specialist. Of these, 96.4% were diagnosed prenatally. According to our results, the effectiveness of first-trimester fetal cardiovascular ultrasound screening conducted by moderately experienced obstetricians in an unselected (’routine’) pregnant population may reach as high as 90% in terms of major congenital heart defects, provided that equipment, quality assurance, and motivation are appropriate....
Loading....