The oxidant capacity is greater with early cord clamping than with delayed clamping or cord milking. Delayed cord clamping or milking are beneficial in neonatal care, and we suggest that they be performed routinely in all deliveries.
Objectives
The aim of this study was to evaluate the impact of tension‐free vaginal tape (TVT) on coital incontinence concomitant with stress urinary incontinence.
Methods
TVT was performed on sexually active women diagnosed with urodynamic stress incontinence (USI) who also experienced coital incontinence with penetration and/or orgasm. The patient‐reported success rate was assessed by the Patient's Global Impression of Improvement (PGI‐I) scale. The sexual function of the women was evaluated by the fulfilled Female Sexual Function Index (FSFI) before and after the operations.
Results
Eighty‐two women underwent the TVT procedure with epidural anesthesia and 80 of them (97%) answered pre‐operative and post‐operative FSFI questionnaires. In the pre‐operative clinical assessment, 48 women (58%) stated they experienced urinary incontinence during penetration, 13 (15%) during orgasm, and 21 (25%) identified it for both. The patient‐reported success rate was 86% (71 of 82 patients) according to the PGI‐I results: 44 of 48 women (91%) during penetration, nine of 13 (69%) during orgasm, and 18 of 21 (85%) for both. The FSFI scores for sexual desire, lubrication, and sexual arousal domains increased in 57 (71%), 49 (61%), and 44 (55%) patients, respectively, whereas they remained unchanged in 23 (28%), 31 (38%), and 36 (45%) patients. For the orgasm, satisfaction, and pain domains, the results were similar. The mean total FSFI score before the operations was 23.63 ± 6.84 and it significantly increased after surgery to 29.47 ± 4.28 (P < .05).
Conclusions
The TVT procedure may offer treatment for coital incontinence accompanying USI. It also provides significant improvement in the sexual lives of women.
Objectives: To compare the 'strictly' active management protocol in women with low risk of postpartum hemorrhage using the expectant management protocol with respect to changes in hematologic parameters, uterotonics, blood transfusions, or additional interventions.
Material and methods:A randomized controlled prospective trial in which 934 singleton parturients enrolled; 654 were randomly assigned to the active and mixed management groups. The primary outcome parameter was the reduction in hemoglobin concentrations due to delivery, and the secondary outcome parameters were changes in hemoglobin of more than 3 g/dL (∆Hb ≥ 3 g/dL), durations of the third stage of labor, need for additional uterotonic agents, blood transfusions, manual removal of the placenta, and surgical evacuation of retained products of conception.
Results:The mean postpartum hemoglobin concentration was significantly higher (P = 0.04) in the active management group with a significantly lower reduction (P = 0.03). Falls of hemoglobin levels of more than 3 g/dL (∆Hb ≥ 3g/dL) were less common in the active management group though not significantly (P = 0.32). The mean duration of the third stage of labor was significantly (P < 0.001) shorter in the active management group. There was no significant difference between the two groups with regard to the need for additional uterotonic agents, uterine atony, blood transfusion, manual removal of the placenta, surgical evacuation of retained products of conception, and prolonged third stage of labor.
Conclusions:Although active management of the third stage of labor was associated with higher postpartum hemoglobin levels, it did not influence the risk of 'severe postpartum hemorrhage' in women with low risk of postpartum hemorrhage.
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