Alice Ka Wah Yiu

Prevalence of levator ani muscle injury in Chinese women after first delivery.

To assess the prevalence of levator ani muscle injury in Chinese women after their first delivery and investigate associated factors.

Chinese validation of Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire

Introduction and hypothesisThe purpose of this study was to investigate the reliability and validity of the Chinese version of Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ).MethodsWomen who presented for pelvic floor disorders completed the Chinese version of PFDI and PFIQ, SF-36, a 3-day urinary and fecal diary. POP-Q assessment, urodynamic study, anal manometry, and ultrasound were performed where appropriate.ResultsFive hundred and ninety-seven women completed the study. The Cronbach’s alpha and test–retest reliability of PFDI and PFIQ was 0.92 and 0.98, and 0.77 and 0.79, respectively. Convergent validity was demonstrated with negative correlation of PFDI and PFIQ with SF-36; positive correlation of staging of prolapse, urinary or fecal incontinent episodes with the respective subscales of PFDI and PFIQ.ConclusionsThe Chinese version of PFDI and PFIQ are reliable and valid condition-specific health-related quality of life questionnaires for women with pelvic floor disorders.

Clinical and psychological impact after surgical, medical or expectant management of first‐trimester miscarriage – a randomised controlled trial

The management of first‐trimester miscarriage has been studied extensively in recent years. However, relatively little attention has been focussed on womans satisfaction and psychological impact from different treatment modalities.

MDSCs drive the process of endometriosis by enhancing angiogenesis and are a new potential therapeutic target

Endometriosis affects women of reproductive age via unclear immunological mechanism(s). Myeloid‐derived suppressor cells (MDSCs) are a heterogeneous group of myeloid cells with potent immunosuppressive and angiogenic properties. Here, we found MDSCs significantly increased in the peripheral blood of patients with endometriosis and in the peritoneal cavity of a mouse model of surgically induced endometriosis. Majority of MDSCs were granulocytic, produced ROS, and arginase, and suppressed T‐cell proliferation. Depletion of MDSCs by antiGr‐1 antibody dramatically suppressed development of endometrial lesions in mice. The chemokines CXCL1, 2, and 5 were expressed at sites of lesion while MDSCs expressed CXCR‐2. These CXC‐chemokines promoted MDSC migration toward endometriotic implants both in vitro and in vivo. Also, CXCR2‐deficient mice show significantly decreased MDSC induction, endometrial lesions, and angiogenesis. Importantly, adoptive transfer of MDSCs into CXCR2‐KO mice restored endometriotic growth and angiogenesis. Together, this study demonstrates that MDSCs play a role in the pathogenesis of endometriosis and identifies a novel CXC‐chemokine and receptor for the recruitment of MDSCs, thereby providing a potential target for endometriosis treatment.

OP34.07: Levator ani muscle injury after first delivery in Chinese primiparous women

Objectives: Vaginal delivery has been identified as risk on pelvic floor; 18–35% of Caucasian women having their first vaginal delivery were found with levator ani muscle injury (LAM). Variation in pelvic connective tissue quality was found between ethnicity. This study aims at examining the prevalence of LAM injury after vaginal delivery in primiparous Chinese women. Methods: Nulliparous Chinese women with singleton pregnancies were recruited. Trans-labial 3D-ultrasound at 35–38 weeks of gestation and 8 weeks post-delivery were performed at rest and at pelvic floor contraction. Demographic and delivery data were collected and the mode of delivery determined by Obstetric indications. Two investigators blinded to the information reviewed the volume data set and searched in its entirety of the continuity of the V-shape LAM. Defects were identified when a loss of continuity within the pubovisceral muscle was visualised. Results: 282 women completed the study, 219 (77.7%) had vaginal delivery including 42 vacuum extractions and 9 forceps; 63 (22.3%) had Caesarean sections (11 elective and 52 emergency). No LAM injury was found antenatally and in the postnatal Caesarean section group. 56 women (25.6%) had LAM injury after vaginal delivery (18 bilateral and 38 unilateral). Instrumental delivery and longer duration of second stage of labour were found statistically associated with LAM injury (Table 1). Conclusions: 25.6% of primiparous Chinese women had levator ani muscle injury after their first vaginal delivery.

P12.01: Pelvic floor biometry after the delivery in Chinese primiparous women

Results: Thirty-eight women were diagnosed of Cesaeran scar defect at TUS. The number of previous Caesarean sections in patients with uterine dehiscence and ectopic pregnancy in Cesarean scar is shown in Table 1. Eleven patients (29%) showed a uterine dehiscence. Seven cases were repaired by laparoscopy and 4 cases required hysterectomy. Five ectopic pregnancies (13%) were diagnosed at TUS. Two patients required hysterectomy, 2 were treated with local methotrexate guided by TUS and 1 was surgically sutured. Two patients (5%) had a complete uterine rupture. One of them diagnosed 6 months after Cesarean section and required hysterectomy. The other which was diagnosed during puerperium period was treated by surgical repair. Conclusions: TUS is useful for detecting Cesarean scar defects providing information for a treatment in case of complications.

OP13.02: Pelvic floor biometries during the first singleton pregnancy in Chinese nulliparous women

Objectives: This study aims at evaluating the pelvic floor biometries during the first pregnancy of Chinese nulliparous women. The relationship with pelvic floor symptoms was also explored. Methods: Nulliparous Chinese women with singleton pregnancies were recruited. They were assessed at 10–13 weeks, 26–28 weeks and 35–38 weeks of gestation. Trans-labial 3D-ultrasound was performed at rest, Valsalva maneuver (VM) and pelvic floor contraction (PFMC) during each visit. Stress urinary incontinence, urgency urinary incontinence and dragging discomfort were also asked during each visit. Offline analysis of USG volume data sets were done by an investigator blinded to the information. Position of the anterior compartment (bladder neck vertical position), middle compartment (most inferior part of cervix) and posterior compartment (ano-rectal junction) and the hiatal dimensions were measured in a standard way. Results: In all, data of 187 women were reported here. Their mean age was 30.4 ± 4.0 years. There were significant descent of all three compartments and enlargement of hiatal area during rest, VM or PFMC as the pregnancy advanced. At second and third trimester, 54 (29%) and 60 (32%) women reported stress urinary incontinence, but there was no association with the bladder neck mobility. And 41 (22%) and 60 (32%) reported symptoms of dragging sensation but there was no association with the hiatal area. Conclusions: There were significant changes of pelvic floor biometries with descent of three compartments at rest, at VM and PFMC as pregnancy advanced. Stress urinary incontinence and dragging sensation were common during pregnancy; however, both were not associated with parameters of pelvic floor biometries.