Falls and Fractures in Patients with Geographic Atrophy: A US Claims Data Analysis.

Introduction: The increased risk of falls in elderly people represents a substantial public health burden that may be compounded by impaired visual acuity. The present study aimed to assess the independent risk of incident falls and fractures in patients with geographic atrophy (GA).

Methods: This retrospective, noninterventional, cohort study analyzed three US claims datasets (Optum's de-identified Clinformatics Data Mart Database [Clinformatics], Merative™ MarketScan Commercial and Medicare Databases [MarketScan], and IQVIA US PharMetrics [PharMetrics]).

Evaluation of Perineal Descent Measurements on Pelvic Floor Imaging.

The aim of this study is to validate a uniform method for measuring perineal descent which can be used for different imaging methods, to establish cut-off values for this measurement, and to assess diagnostic test accuracy (DTA) of imaging techniques using these cut-off values. Secondly, the study aims to correlate perineal descent to symptoms, signs and imaging findings in women with obstructed defaecation syndrome (ODS) to assess its clinical relevance. Cross-sectional study of 131 women with symptoms of ODS.

Episiotomy: Are Indian Obstetricians Getting the Angle Right?

Background: A mediolateral episiotomy is recommended when indicated at a 60° angle at crowning, to avoid obstetric anal sphincter injuries (OASIs) by episiotomies angled too close or distant to the anus. This study surveyed obstetricians in India regarding the recommended episiotomy angle and their ability to correctly draw the angle.

Methods: Workshops were conducted in India to share knowledge in the prevention and repair of OASIs.

Obstetric risk factors for levator ani muscle avulsion: A systematic review and meta-analysis.

Objectives: Women have a 11% lifetime risk of undergoing surgery for vaginal prolapse. Levator ani muscle (LAM) avulsion is one etiological factor associated with primary and recurrent pelvic organ prolapse. Pelvic organ prolapse has been shown to greatly affect the quality of life and well-being of women.

UK survey of colorectal surgeons on the management of acute obstetric anal sphincter injuries.

Aim: The role of colorectal surgeons in the management of acute obstetric anal sphincter injury (OASI) is an ongoing debate. Their expertise in operating in the anorectal region lends itself to assisting in OASI repair. The aim of this study was to establish the current involvement and recommended management of acute OASI by colorectal surgeons.

The prevention of perineal trauma during vaginal birth.

Perineal trauma after vaginal birth is common, with approximately 9 of 10 women being affected. Second-degree perineal tears are twice as likely to occur in primiparous births, with a incidence of 40%. The incidence of obstetrical anal sphincter injury is approximately 3%, with a significantly higher rate in primiparous than in multiparous women (6% vs 2%).

Diagnosis, management and training in perineal trauma: a UK national survey of obstetricians.

Introduction And Hypothesis: Perineal trauma during vaginal delivery is very common. Training in diagnosis and repair of trauma, including obstetric anal sphincter injuries, varies in the UK. We aimed to investigate the current knowledge and training received by obstetric physicians.

Postpartum perineal wound infection and its effect on anal sphincter integrity: Results of a prospective observational study.

Introduction: Perineal wound infection can affect tissues at superficial, deep, and organ space levels. Women with obstetric anal sphincter injuries (OASIS) are at risk of infection; however, no study to date has investigated if infection can extend to affect the anal sphincter integrity. The aim of this study was to evaluate the clinical progression of perineal wound infection and its effect on the anal sphincter in women with or without OASIS using three-dimensional endoanal ultrasound (3D-EAUS).

Getting the size right: Are clinicians ready for it?

Objectives Digital examination has many uses in obstetrics and gynaecology, including cervical assessment in labour and measuring for vaginal pessaries. Clinicians must be adequately trained to perform accurate digital assessments and use this information to make decisions. We aimed to evaluate the accuracy of a clinician’s estimate for three different measuring tasks and assess whether there was any difference in the accuracy in relation to seniority or job role.

The incidence of anal incontinence following obstetric anal sphincter injury graded using the Sultan classification: a network meta-analysis.

Objective: This study aimed to systematically determine and compare the incidence of anal incontinence between those with different grades of obstetric anal sphincter injury.

Data Sources: Ovid MEDLINE, Embase, and the Cochrane Library were searched from January 2000 to April 2021.

Study Eligibility Criteria: Observational studies investigating the incidence of anal incontinence following an obstetric anal sphincter injury that was graded using the Sultan classification were eligible for inclusion.

Bacterial autofluorescence in infected perineal wounds: A prospective cohort study.

Diagnosis of perineal wound infection based solely on clinical signs and symptoms is subjective, and often incorrectly identifies wounds with clinically significant bacterial loads. New advances in wound care such as bacterial fluorescence imaging allow point-of -care assessment of bacterial burden. This single-center, prospective observational study included 80 women with perineal wound infection and aimed to determine the incidence of significant bacterial colonization identified with bacterial fluorescence imaging.

Can transperineal ultrasound improve the diagnosis of obstetric anal sphincter injuries?

Introduction And Hypothesis: Women with missed obstetric anal sphincter injuries (OASIs) are at an increased risk of anal incontinence. Our aim was to assess the accuracy of three-dimensional (3D) transperineal ultrasound (TPUS) compared with clinical examination for detecting OASIs.

Methods: A cross-sectional study of women undergoing their first vaginal delivery.

The clinical progression and wound healing rate of dehisced perineal tears healing by secondary intention: A prospective observational study.

Objectives: To establish the clinical progression of dehisced perineal wounds healing by secondary intention and to investigate the incidence and factors associated with delayed healing.

Methods: Secondary analysis of women with perineal wound dehiscence recruited into the PERINEAL study between August 2020- August 2021 (NCT04480684). Three-dimensional wound measurements were taken with the Silhouette® camera.

The incidence of wound complications following primary repair of obstetric anal sphincter injury: a systematic review and meta-analysis.

Objective: We aimed to systematically determine the incidences of wound infection and dehiscence after primary obstetric anal sphincter injury repair.

Data Sources: MEDLINE, Embase, CINAHL, EmCare, the Cochrane Library, and Trip Pro databases were searched from inception to February 2021.

Study Eligibility Criteria: We included observational clinical studies reporting the incidences of wound infection and dehiscence after primary obstetric anal sphincter injury repair.

Mediolateral/lateral episiotomy with operative vaginal delivery and the risk reduction of obstetric anal sphincter injury (OASI): A systematic review and meta-analysis.

Introduction And Hypothesis: OASI complicates approximately 6% of vaginal deliveries. This risk is increased with operative vaginal deliveries (OVDs), particularly forceps. However, there is conflicting evidence supporting the use of mediolateral/lateral episiotomy (MLE/LE) with OVD.

Is there a role for transperineal ultrasound imaging of the anal sphincter immediately after primary repair of third degree tears?

Objective: When obstetric anal sphincter injuries are identified, it is crucial that the defects are repaired appropriately to achieve a better outcome. Although the presence of an intact anal sphincter is not the sole mechanism for maintaining continence, and not all women with an anal sphincter defect are symptomatic, there is an association between sphincter defects and anal incontinence. Our aim was to evaluate whether transperineal ultrasound (TPUS) is useful in assessing anal sphincter integrity immediately following primary repair of obstetric anal sphincter injuries (OASIs).

Under-classified obstetric anal sphincter injuries.

Introduction And Hyposthesis: Obstetric anal sphincter injuries (OASIs) that are missed at delivery can have long-term consequences. OASIs that are under-classified at delivery are likely to be inadequately repaired, resulting in a persistent anal sphincter defect. We aimed to identify women who have persistent defects on endoanal ultrasound, inconsistent with the original diagnosis, and compare the effect on St Mark's incontinence scores (SMIS).

Treatments for Chronic Kidney Disease: A Systematic Literature Review of Randomized Controlled Trials.

Delaying disease progression and reducing the risk of mortality are key goals in the treatment of chronic kidney disease (CKD). New drug classes to augment renin-angiotensin-aldosterone system (RAAS) inhibitors as the standard of care have scarcely met their primary endpoints until recently. This systematic literature review explored treatments evaluated in patients with CKD since 1990 to understand what contemporary data add to the treatment landscape.

Healing of disrupted perineal wounds after vaginal delivery: a poorly understood condition.

Perineal injury following childbirth can result in complications such as wound infection and dehiscence. The reported incidence of these complications in the literature range between 0.1-23.

Imaging modalities for the detection of posterior pelvic floor disorders in women with obstructed defaecation syndrome.

Background: Obstructed defaecation syndrome (ODS) is difficulty in evacuating stools, requiring straining efforts at defaecation, having the sensation of incomplete evacuation, or the need to manually assist defaecation. This is due to a physical blockage of the faecal stream during defaecation attempts, caused by rectocele, enterocele, intussusception, anismus or pelvic floor descent. Evacuation proctography (EP) is the most common imaging technique for diagnosis of posterior pelvic floor disorders.