We performed a systematic review to identify all studies evaluating the success rates of treatment of major postpartum hemorrhage by uterine balloon tamponade, uterine compression sutures, pelvic devascularization, and arterial embolization. We included studies reporting on at least 5 cases. All searches were performed independently by 2 researchers and updated in June 2006. Failure of management was defined as the need to proceed to subsequent or repeat surgical or radiological therapy or hysterectomy, or death. As the search identified no randomized controlled trials, we proceeded to search for observational studies. This identified 396 publications, and after exclusions, 46 studies were included in the systematic review. The cumulative outcomes showed success rates of 90.7% (95% confidence interval [CI], 85.7%-94.0%) for arterial embolization, 84.0% (95% CI, 77.5%-88.8%) for balloon tamponade, 91.7% (95% CI, 84.9%-95.5%) for uterine compression sutures, and 84.6% (81.2%-87.5%) for iliac artery ligation or uterine devascularization (P = 0.06). At present there is no evidence to suggest that any one method is better for the management of severe postpartum hemorrhage. Randomized controlled trials of the various treatment options may be difficult to perform in practice. As balloon tamponade is the least invasive and most rapid approach, it would be logical to use this as the first step in the management.

Morbidly adherent placenta is often associated with severe maternal morbidity. An increased incidence over the recent years may be secondary to the increased cesarean section rates. Identification of patients with risk factors antenatally is essential for the early diagnosis and management. Diagnosis can be achieved by ultrasound or MRI in the majority of cases. Management aims to ensure a safe delivery of the fetus, alongside measures of prevention or effective management of postpartum hemorrhage. When a hysterectomy is performed, a multidisciplinary team with surgical expertise and facilities for transfusion and further interventions including arterial ligation and interventional radiology should be available. The options for conservative treatments offer the potential to preserve fertility but further research with prospective evaluation of the different approaches is necessary.

Aims To review the recommendations on basic urodynamic testing in the International Continence Society (ICS) standardization documents, specifying key recommendations for delivery and interpretation in clinical practice. Methods Fundamental expectations described in the ICS standards on good urodynamic practices, urodynamic equipment, and terminology for lower urinary tract (LUT) function were identified and summarized. Results The ICS standard urodynamic protocol includes clinical history, including symptom and bother score(s), examination, 3‐day voiding chart/diary, representative uroflowmetry with post‐void residual, and cystometry with pressure‐flow study (PFS). Liquid filled catheters are connected to pressure transducers at the same vertical pressure as the patient's pubic symphysis, taking atmospheric pressure as the zero value. Urodynamic testing is done to answer specific therapy‐driven questions for treatment selection; provocations are applied to give the best chance of reproducing the problem during the test. Quality of recording is monitored throughout, and remedial steps taken for any technical issues occurring during testing. Labels are applied during the test to document events, such as patient‐reported sensation, provocation tests, and permission to void. After the test, the pressure and flow traces are scrutinized to ensure artefacts do not confound the findings. An ICS standard urodynamic report details the key aspects, reporting clinical observations, technical, and quality issues. Urodynamic services must maintain and calibrate equipment according to manufacturer stipulations. Conclusions The review provides a succinct summary of practice expectations for a urodynamic unit offering cystometry and pressure flow studies (PFS) to an appropriate standard.

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Background Uterine-sparing surgical interventions have long been practiced as an alternative to hysterectomy in the management of severe postpartum haemorrhage (PPH); however, the risks of impairment of subsequent fertility from such procedures are unclear.Objective To evaluate the menstrual and fertility outcomes following radiological or conservative surgical interventions for severe PPH.Search strategy A systematic review of English and non-English articles using the Cochrane Library 2012, PubMed (1950PubMed ( -2012, Embase (1980Embase ( -2012, and the National Research Register. The keywords used for our search included 'fertility', 'reproductive outcome', 'postpartum haemorrhage', 'embolisation', 'hypogastric artery ligation', 'B-Lynch suture', 'stepwise uterine devascularisation', 'tamponade', and 'uterine compression sutures'.Selection criteria Studies including human female subjects with at least five cases.Data collection and analysis Independent extraction of articles by two authors using predefined data fields, including study quality indicators.Main results We identified 402 publications and after exclusions, 28 studies were included in the systematic review. Seventeen studies (675 women) reported on the fertility outcomes after uterine artery embolisation, five studies (195 women) reported on the fertility outcomes after uterine devascularisation, and six studies (125 women) reported on the fertility outcomes following uterine compression sutures. Overall, 553 out of 606 (91.25%) women resumed menstruation within 6 months of delivery. One hundred and eighty-three out of 235 (77.87%) women who desired another pregnancy achieved conception.Author's conclusions Uterine-sparing radiological and surgical techniques for the management of severe PPH do not appear to adversely affect the menstrual and fertility outcomes in most women; however, the number of studies and the quality of the available evidence is of concern.

Instrumental vaginal deliveries carry substantial risks. Only practitioners who are adequately trained or are under supervision should undertake instrumental delivery. The mode of intervention needs to be individualized after consideration of the operator's skills and experience and the clinical circumstances.

Placement of a SBOC successfully treats atonic PPH refractory to medical management in around 80% of cases. It is simple, inexpensive and in those with successful placement no surgical morbidity was observed. The potential for it to be used by inexperienced operators in areas with limited resources makes it a useful adjunct in management of PPH.

PAHG is a safe intervention for treating women with stress urinary incontinence, but repeat injections are often required. Further research is mandated in the field in order to compare its efficacy to other bulking agents.