As compared with intravenous paclitaxel plus cisplatin, intravenous paclitaxel plus intraperitoneal cisplatin and paclitaxel improves survival in patients with optimally debulked stage III ovarian cancer.

In patients with advanced ovarian cancer, a chemotherapy regimen consisting of carboplatin plus paclitaxel results in less toxicity, is easier to administer, and is not inferior, when compared with cisplatin plus paclitaxel.

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This study was conducted to identify the method of laparoscopic entry used by practicing gynecologists and learn whether they are following new recommendations for improvement of the safety of laparoscopic gynecologic surgery. Several international societies of endoscopy have endorsed new guidelines for safe laparoscopic entry techniques. Physicians are advised to place the primary incision in the base of the umbilicus when performing closed laparoscopy. If adhesions are suspected, the incision can be made in Palmer's point. Intraabdominal pressure should be 25 mm Hg for trocar insertion. In open laparoscopy, the incision should be made at the lower border of the umbilicus and care taken to elevate the deep fascia to separate the abdominal wall from its contents. Secondary trocars should be inserted under direct laparoscopic guidance.The authors mailed an anonymous questionnaire about laparoscopic techniques to all gynecologists in the United Kingdom and Ireland (n ϭ 1190). They received 764 (64%) responses.A large majority (90%) of responders used a closed entry technique with a Veress needle, 8% preferred a direct entry technique without a pneumoperitoneum, and 1% each used Hasson's method or a combination of open and closed laparoscopy. The patient positions used in performing laparoscopy were lithotomy with Trendelenburg tilt (61%), the flat position (29%), or a combination of positions (10%).Over half of respondents (54%) used a subumbilical entry point, 44% preferred an intraumbilical entry point, 2% used a suprapubic entry, and 2% used a combination of sites. Only 44% indicated that they performed a check test to assure correct positioning of the Veress needle; when used, Palmer's aspiration technique was used most often (90%).Sixty-two percent of responders used volume (range, less than 2.0-3.5) and 38% used the intraabdominal pressure technique (range, 15-25 mm Hg) to establish a satisfactory pneumoperitoneum before trocar insertion.Half of the responding gynecologists (53%) said that they would use their preferred techniques for all patients, regardless of a patient's history. Forty-seven percent would change their techniques for obese patients or those who had prior abdominal surgery. One third (34%) indicated that their techniques had changed in the past 5 years.Thirty-four percent of the responders had attended a laparoscopic or endoscopic surgery course in the past and 66% had not. Those who had attended a course were more likely to follow the new recommendations for safe laparoscopy (69%). Only 26% of responders were aware of the new guidelines, whereas 74% were not aware of these recommendations. GYNECOLOGY ABSTRACTTo identify the preoperative and intraoperative factors that might affect the outcome from a tension-free vaginal tape (TVT) procedure for the treatment of stress urinary incontinence (SUI), 809 participants were recruited from women scheduled to undergo TVT between March 2000 and September 2001. Patients with recurrent urinary tract infections, symptoms of urge incontinence greater tha...

This study describes the pathology and clinical information on 20 placentas whose mother tested positive for the novel Coronovirus (2019-nCoV) cases. Ten of the 20 cases showed some evidence of fetal vascular malperfusion or fetal vascular thrombosis. The significance of these findings is unclear and needs further study.

Objective To describe differences in outcomes between pregnant women with and without coronavirus dsease 2019 (COVID-19). Design Prospective cohort study of pregnant women consecutively admitted for delivery, and universally tested via nasopharyngeal (NP) swab for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) using reverse transcription-polymerase chain reaction. All infants of mothers with COVID-19 underwent SARS-CoV-2 testing. Setting Three New York City hospitals. Population Pregnant women >20 weeks of gestation admitted for delivery. Methods Data were stratified by SARS-CoV-2 result and symptomatic status, and were summarised using parametric and nonparametric tests. Main outcome measures Prevalence and outcomes of maternal COVID-19, obstetric outcomes, neonatal SARS-CoV-2, placental pathology. Results Of 675 women admitted for delivery, 10.4% were positive for SARS-CoV-2, of whom 78.6% were asymptomatic. We observed differences in sociodemographics and comorbidities among women with symptomatic COVID-10 versus asymptomatic COVID-19 versus no COVID-19. Caesarean delivery rates were 46.7% in symptomatic COVID-19, 45.5% in asymptomatic COVID-19 and 30.9% in women without COVID-19 (P = 0.044). Postpartum complications (fever, hypoxia, readmission) occurred in 12.9% of women with COVID-19 versus 4.5% of women without COVID-19 (P < 0.001). No woman required mechanical ventilation, and no maternal deaths occurred. Among 71 infants tested, none were positive for SARS-CoV-2. Placental pathology demonstrated increased frequency of fetal vascular malperfusion, indicative of thrombi in fetal vessels, in women with COVID-19 versus women without COVID-19 (48.3% versus 11.3%, P < 0.001). Conclusion Among pregnant women with COVID-19 at delivery, we observed increased caesarean delivery rates and increased frequency of maternal complications in the postpartum period. Additionally, intraplacental thrombi may have maternal and fetal implications for COVID-19 remote from delivery.

No abstract

The purpose of this study was to assemble and test the reliability of a complete set of the placental reaction patterns seen with chronic fetal vascular obstruction in the hope that this might provide a standardized diagnostic framework useful for practicing pathologists. Study cases (14 with fetal vascular obstructive lesions, 6 controls) were reviewed blindly by seven pathologists after agreement on a standard set of diagnostic criteria. Majority vote served as the gold standard and 80% of the 180 diagnoses rendered (9 diagnoses each for 20 cases) were agreed upon by at least six of the seven scores. The sensitivity of individual diagnosis relative to the group consensus averaged 83% (range, 69-100%) and specificity averaged 91% (range, 86-100%). Reproducibility was measured by unweighted kappa-values and interpreted as follows: < 0.2, poor; 0.2-0.6, fair/moderate; > 0.6, substantial. Kappa values for lesions of distal villi were generally superior to those for lesions involving large fetal vessels: avascular villi (0.49), villous stromal-vascular karyorrhexis (0.58), and villitis of unknown etiology (VUE) with stem villitis and avascular villi (0.65) versus large vessel thrombi (any vessel, 0.34; chorionic plate vessel, 0.40) and intimal fibrin cushions (recent, 0.47; remote, 0.78). Reproducibility for a global impression of any villous change consistent with chronic fetal vascular obstruction was substantial (0.63), while that for a more severe subgroup was moderate (0.44). Three points are worthy of emphasis. Our system separately recognizes, but later combines, uniformly avascular villi and villous stromal-vascular karyorrhexis as manifestations of the same underlying process. We propose that this combined group of villous lesions be dichotomized with the terms fetal thrombotic vasculopathy or extensive avascular villi (and/or villous stromal-vascular karyorrhexis) being reserved for the group with 15 or more affected terminal villi per section. Scattered foci of avascular villi (and/or villous stromal-vascular karyorrhexis) could be used to describe less severe cases. Finally, we distinguish VUE with stem villitis and avascular villi (obliterative fetal vasculopathy) as a distinct process with substantial perinatal morbidity.