Georgios Vlachos

Risk factors for severe perineal lacerations during childbirth

Severe perineal lacerations represent a significant complication of normal labor with a strong impact on quality of life.

First versus second stage C/S maternal and neonatal morbidity: a systematic review and meta-analysis.

The rates of cesarean section at full cervical dilatation (second stage cesarean sections) are currently increasing. The purpose of the present study is to compare maternal and neonatal morbidity and mortality among cases offered cesarean section at full dilatation to those offered cesarean section prior to full dilatation. We searched Medline, Scopus, Clinicaltrials.org, Popline, Cochrane CENTRAL, and Google Scholar search engines, along with reference lists from all included studies. The RevMan 5.0 software was used for all analyses. Primary maternal outcomes were defined as death, ICU admission and need for transfusion, while primary neonatal outcomes were defined as death, neonatal unit admission and 5min Apgar score less than 7. Ten studies were finally retrieved involving 23,104 singleton childbearing women (18,160 operated in the first stage and 4944 in the second stage of labor). Second stage cesarean section seems to lead to higher maternal admissions to ICU (OR 7.41, 95% CI 2.47-22.5) and higher transfusion rates (OR 2.60, 95% CI 1.49-2.54). Neonatal death rates were also increased (OR 5.20, 95% CI 2.49-10.85) along with admissions to neonatal unit (OR 1.63, 95% CI 0.91-2.91) and rates of Apgar score less than 7 in 5min (OR 2.77, 95% CI 1.02-7.50). Second stage cesarean section seems to result significantly increased morbidity for both mothers and neonates. It seems that a direct evaluation with forceps and vacuum extractors is imperative in order to establish its place in modern evidence-based practice.

Oxytocin discontinuation after the active phase of labor is established

Abstract Despite the widespread usage of oxytocin, there is still no consensus on its mode of administration. The scope of the present meta-analysis was to assess the effect of oxytocin discontinuation after the active phase of labor is established on maternal fetal and neonatal outcomes. We searched Medline, Scopus, Popline, ClinicalTrials.gov and Google Scholar databases. Eight studies were finally retrieved, which involved 1232 parturient. We observed significantly decreased rates of cesarean sections among parturient that discontinued oxytocin (OR 0.51, 95% CI 0.35, 0.74) as well as decreased rates of uterine hyperstimulation (OR 0.33, 95% CI 0.19, 0.58). Similarly, cases of non-reassuring fetal heart rates were fewer among women that did not receive oxytocin after the establishment of the active phase of labor (OR 0.63, 95% CI 0.41, 0.97). Keeping in mind the aforementioned maternal and neonatal adverse effects that seem to result from infusion of oxytocin until delivery, future practice should aim towards its discontinuation after the establishment of the active phase of labor, as it does not seem to influence the total duration of labor. Future studies should aim towards specific populations of parturient in order to clarify whether different approaches are needed.

Teenage pregnancy antenatal and perinatal morbidity: Results from a tertiary centre in Greece

Abstract We present the experience of a tertiary referral hospital in Greece, evaluating obstetric and perinatal outcomes among teenage and average maternal age (AMA) women. We retrospectively assessed all singleton pregnancies during a twelve-month period (January–December 2012). A total of 1,704 cases were reviewed and divided into two groups: one of AMA mothers (20–34 years old) (1,460 women) and the other of teenage mothers (12–19 years old) (244 women). We observed significantly higher incidence rates of preterm births (p < 0.001), preterm premature rupture of the membranes (p < 0.001), gestational hypertension (p < 0.001), preeclampsia (p = 0.043) and Apgar scores < 7 at 5 min (p = 0.015) among teenage mothers. Antenatal surveillance was decreased among teenage mothers (p < 0.001), while rates of anaemia were higher (p < 0.001). Teenage pregnancy is accompanied by significant antenatal and perinatal complications that need specific obstetrical attention. Obstetricians should be aware of these complications in order to ameliorate the antenatal outcome of childbearing teenagers.

Double versus single cervical cerclage for the prevention of preterm births.

Abstract Objective: To evaluate the effectiveness double cervical cerclage in reducing antenatal complications and improve perinatal outcomes. Methods: We searched Medline, Scopus, Clinicaltrials.org, The Cochrane Central Register of Controlled Trials and Google Scholar search engines. Results: Six studies were included that involved 880 women. Double cerclage was significantly superior to single cerclage in reducing preterm births <34 weeks (734 cases, OR 0.59, 95% CI 0.40, 0.86) and preterm births <28 weeks (645 cases, OR 0.43, 95% CI 0.26–0.73). It also significantly increased the gestational age (380 cases, MD 2.63, 95% CI 0.87, 4.39). However, as a technique, it failed to improve the rates of preterm births <37 weeks (740 cases, OR 0.98, 95% CI 0.72, 1.34) the incidence of chorioamnionitis (740 cases, OR 0.83, 95% CI 0.51, 1.36) and the occurrence of preterm premature rupture of the membranes (796 cases, OR 1.32, 95% CI 0.95, 1.82). Conclusions: It seems that double cerclage effectively increases the gestational age at delivery and decreases the rates of extremely premature births. However, as a procedure, it does not reduce the incidence of antenatal morbidity or the neonatal death rates. Further research is needed in the field as our meta-analysis is limited by the small number of enrolled studies.

Erratum to: Electrosurgical bipolar vessel sealing for vaginal hysterectomies

As “Intraoperative complications” we specifically included in the present erratum every complication that arose during the initial procedure. These included intraoperative blood loss requiring transfusion or intraoperative blood loss of more than 500 ml, bladder damage, rectal damage. Skin burns were excluded from the present erratum because we feel that they do not represent a life-threatening complication and that they are not as severe as abdominal visceral organ damage. As “Postoperative complications” we included in the present erratum every complication that arose after the completion of the initial procedure, either during the hospitalization period or after this period had ended. “Major postoperative complications” were the following: repetition of laparotomy, re-admission to the hospital, hemorrhage requiring transfusion, hemorrhage stated by the authors as severe or resulting in blood loss of more than 500 ml and hematoma formation. As “Minor postoperative complications” we included cases of postoperative blood loss that did not necessitate blood transfusion and were not stated by the initial authors as severe, any febrile cases and any cases experiencing infectious diseases of the lower abdomen that did not require surgical treatment and cases experiencing urinary tract infections.

O126 The role of secondary cytoreductive surgery in the treatment of patients with recurrent ovarian cancer

Background: Primary cytoreduction is the cornerstone of treatment in epithelial ovarian cancer and has shown to improve survival. The role of secondary cytoreduction in cases of recurrence is less clear. The aim of this study is to assess the impact of secondary cytoreduction on survival of patients with recurrent epithelial ovarian carcinoma. Methods: We retrospectively reviewed 33 patients with recurrent ovarian cancer who underwent secondary cytoreductive surgery from 2000 to 2007. All patients had been initially treated with primary cytoreduction in our institution and received platinum based chemotherapy postoperatively. Disease free interval after primary treatment had to be more than 6 months. Results: Median time to recurrence was 23 months (range 7–240), while median survival after secondary surgery was 25 months (range 2–96). An optimal secondary cytoreduction (residual tumor <1 cm) was accomplished in 19 patients (57.5%). Statistical analysis showed that when optimal secondary cytoreduction was achieved, survival was improved (Residual disease: >1 cm versus <1 cm, 18 months versus 31 months respectively, p < 0.05). Moreover, survival was significantly related to time of recurrence (6–24 months versus >24 months, 19 months versus 34 months respectively, p < 0.05), to residual disease after primary cytoreduction (>1 cm versus <1 cm, 21 months versus 34 months respectively) but not with FIGO stage, tumor grade, presence of ascites or number of recurrence sites. Conclusion: When feasible, secondary cytoreduction in patients with recurrent ovarian cancer seems to be improving survival. Patients who had an optimal primary cytoreduction and disease free interval >24 months are more likely to benefit the most.