OC20.01: Who should perform obstetrics ultrasound in the primary health care centers? A need to be consequent with our reality

Abstract

Oral communication abstracts Methods: This was an external audit of 100 patients after laparoscopic sacrocolpopexy. All had a standardised interview, clinical prolapse assessment (ICS POPQ) and transperineal ultrasound (TPUS) with GE Voluson 730 Expert or S6 systems. Recurrence was defined as either 1) recurrent symptoms of prolapse, 2) Ba ≥ −1, or 3) bladder descent ≥ 10mm below symphysis pubis on TPUS. Mesh was identified in the three orthogonal planes at rest and on maximum valsalva. Mesh mobility was assessed with the formula √ ([Xvalsalva-Xrest]2 + [Yvalsalva-Yrest]2). Results: Mean follow-up interval was 3.06 yrs (0.13-6.87). Thirtyone patients reported recurrent symptoms of prolapse. There were 84 patients with clinical prolapse recurrence; 60 in the anterior and 47 in the posterior compartment, but none apically. Mesh could be identified in 60 patients. Its lowermost aspect was located on average 26 mm (SD 13) from the bladder neck at rest and 48 mm (SD 25) on Valsalva. Lowest mesh position and mesh mobility on valsalva were associated with recurrent cystocele. For every mm of distance from the bladder neck on Valsalva, the likelihood of cystocele recurrence was increased by 6-7% (P= 0.001). Conclusions: Cystocele recurrence following laparoscopic sacrocolpopexy is common, and it seems that such recurrence is related to mesh position and mobility. The lower the mesh reaches towards the bladder neck, the lower is the likelihood of anterior compartment recurrence. It may therefore be beneficial to develop techniques that reliably extend sacrocolpopexy mesh to the bladder base. OC19.05 Levator ani muscle injury after instrumental delivery in Chinese primiparous women