Long-term outcomes of laparoscopic repair of cystocoele.

Background: There is little information on the effectiveness of laparoscopic techniques for native tissue repair of cystocoele.

Aim: To assess the long-term outcome of laparoscopic cystocoele repair.

Methods: Two hundred and twenty-three women with symptomatic pelvic organ prolapse underwent laparoscopic paravaginal repair and treatment of associated conditions.

Influence of an Intervention to Prevent Early Childhood Caries Initiated before Birth on Children's Use of Dental Services up to 7 Years of Age.

Background: In a previously reported randomised controlled trial, advising first time mothers on the prevention of early childhood caries from before their child was born, decreased the prevalence of early childhood caries at 20 months of age 5-fold.

Objective: We examined the effect of the intervention on the frequency and nature of dental visits up to 7 years of age.

Methods: Of 649 expectant mothers who participated in the trial, 277 completed a "Child Oral Health Survey" 7 years later.

Reflections on the maternal mortality millennium goal.

Background: Nearly every 2 minutes, somewhere in the world, a woman dies because of complications of pregnancy and childbirth. Every such death is an overwhelming catastrophe for everyone confronted with it. Most deaths occur in developing countries, especially in Africa and southern Asia, but a significant number also occur in the developed world.

A laparoendoscopic single-site surgery approach to mesh sacrohysteropexy.

Although laparoendoscopic single-site surgery (LESS) has spread across surgical disciplines, this has not been the case for the repair of uterovaginal prolapse. We describe the use of this technique for mesh sacrohysteropexy to correct a global prolapse classified as stage II on the pelvic organ prolapse quantification (POP-Q) system. The procedure involved intraoperative modification of a commercially available single incision port.

Effect of uterine preservation on outcome of laparoscopic uterosacral suspension.

Study Objective: To compare the objective outcome of laparoscopic uterosacral hysteropexy with that of hysterectomy combined with laparoscopic uterosacral colpopexy.

Design: Retrospective cohort study, 1999-2010 (Canadian Task Force classification II-2).

Setting: University hospital in South Australia.

Evidence-based medicine and perinatal care: from dawn to dusk.

Since the concept of "evidence-based medicine" was first launched 20 years ago as a new method of teaching the practice of medicine, it has had an enormous impact on practice in many fields of health care. From the very start, professionals in pregnancy and perinatal care were at the forefront of attempts to collect good evidence systematically on the benefits and harms of health care interventions during pregnancy and in and around childbirth. Perinatal practice has largely benefitted from that endeavor.

In the literature: dispelling hallucinations about birthweight: how hard is it?

Birthweight is an important determinant of perinatal outcome and future health well into adulthood. Before weighing newborn infants became enshrined in practice, birthweights tended to be based on an educated guess or, as alleged by Roederer in 1753, on hallucination. Two centuries later, they led to a Babylonic confusion between weight and maturity at birth.

In the literature: home birth: safe enough, but not for the first baby.

The "Birthplace in England" study compared low-risk pregnancies by planned place of birth at the onset of labor: home, midwifery unit, or obstetric unit. The study showed that childbirth interventions were less frequent in all nonobstetric settings than in obstetric units, confirming what has been noted elsewhere. For parous women, there was no difference in perinatal outcomes by place of birth.

The language of birth.

Our language both reflects and influences our attitudes and behavior. This Roundtable Discussion explores the language used in obstetrics and in the interactions between caregivers and women or their families: What do practitioners say to mothers and families during labor? At birth? In consultations? To describe what is happening? To encourage a woman's efforts? To lighten the atmosphere? When advising about possible interventions? Medical terminology in perinatal care can often be deceptive or confusing, not only for mothers but for caregivers. The authors of this Roundtable, representing health professionals from different specialties and interests in the field, have examined some examples of such language use, misuse, and abuse in perinatal care.

Influence of first-time mothers' early employment on severe early childhood caries in their child.

Aim. To examine whether mothers' early employment status is related to the development of severe early childhood caries in their child. Methods.

Precise mid-trimester placenta localisation: does it predict adverse outcomes?

Background: A low-lying placenta detected at the mid-pregnancy ultrasound is commonly reported to warn against potential morbidity associated with placenta praevia. There is no information on what distance away from the internal cervical os is safe.

Aims: We examined whether a low-lying placenta not overlapping the cervical os in the second trimester increases the risk of obstetric complications and whether there is a cut-off point at which that increase occurs.

Laparoscopic supralevator repair for combined apical and posterior compartment prolapse.

Study Objective: To analyze the objective outcome of laparoscopic supralevator repair in the treatment of rectoenterocele with the Pelvic Organ Prolapse Quantification (POPQ) system.

Study Design: Retrospective cohort study 1999-2009 (Canadian Taskforce Classification II-2).

Setting: University hospital in South Australia.

Use of surgisis for treatment of anterior and posterior vaginal prolapse.

Aim. To evaluate the anatomical success and complication rate of Surgisis in the repair of anterior and posterior vaginal wall prolapse. Methods.

Effect of motherhood on women's preferences for sources of health information: a prospective cohort study.

To examine what sources of health information are preferred by first-time mothers-to-be and how these preferences change by the time their child reaches school age. Women expecting their first child (n = 649), recruited in a randomized trial of early childhood caries prevention at all five public maternity hospitals in Adelaide, were questioned about their preferences for health information. Their preferences were assessed again 4 and 7 years later.

Reassessment at 6-7 years of age of a randomized controlled trial initiated before birth to prevent early childhood caries.

Objectives: To assess whether the effect of providing mothers with guidance during pregnancy and when the child was 6 and 12 months old, which had drastically reduced the prevalence of early childhood caries at 20 months of age, would be sustained at 6-7 years of age.

Methods: Children, whose mothers had been enrolled in a randomized controlled trial during pregnancy and a comparison group of similar school children, were examined for the presence of caries by the South Australian School Dental Services (SA SDS) at 6-7 years of age.

Results: Of 625 eligible trial participants, 277 (44%) participated in the follow-up and dental records were available for 187 of them (30%).

Mothers' level of education and childbirth interventions: A population-based study in Flanders, Northern Belgium.

Background:   Interventions to influence the time and way to be born have been a global concern for decades. Yet, limited information is available on what drives these interventions and their variation in frequency among countries, institutions, and practitioners. The objective of this study was to examine to what extent first-time mothers' educational achievement contributes to the frequency of childbirth interventions.

How first-time mothers perceive and deal with teething symptoms: a randomized controlled trial.

Background: Teething, especially in their first child, continues to be a daunting problem for parents.

Objective: The objective of this paper was to assess the effects of providing first-time mothers with information about symptoms commonly associated with teething and ways to manage these.

Methods: In a randomized controlled trial to decrease the incidence of early childhood caries, we included information on teething as another issue in a child's oral health.

Discovering the Holy Grail in postpartum uterine involution.

A Swiss study attempted to establish normal values for the uterine involution expected during the first 5 days postpartum. Two methods were used, apparently independently and without validation. One, named the finger method, consisted of estimating the height of the uterine fundus in finger breadths above or below the umbilicus.

Home birth: gone away, gone astray, and here to stay.

Home birth has attracted a great deal of attention of late, culminating in a meta-analysis to assess its risks for mother and baby. Mothers were estimated to be 2.6 times more likely to die and babies 3 times more likely to die from a planned home birth than from a planned hospital birth.

Elective induction, selective deduction, and cesarean section.

A recent systematic review found no "good quality evidence" that elective induction of labor confers substantial benefits to either mothers or babies, but concluded that elective induction is associated with a decreased risk of "cesarean delivery." Admittedly, elective induction was qualified as "at 41 weeks of gestation and beyond" with 42 weeks being proclaimed as the cutoff point between "elective" and "medically indicated." Major predictors of the success of any induction and the subsequent mode of delivery, such as parity and cervical status, were not taken into account.

Dealing with missing outcomes: lessons from a randomized trial of a prenatal intervention to prevent early childhood caries.

Severe early childhood caries (S-ECC) affects 17% of 2-3 year old children in South Australia impacting on their general health and well-being. S-ECC is largely preventable by providing mothers with anticipatory guidance. Randomised controlled trials (RCTs) are the most decisive way to test this, but that approach suffers from near inevitable loss to follow-up that occurs with preventative strategies and distant outcome assessment.