September update
Bowel prep, the sonopartogram, vacuum, heat and pregnancy, OASI outcomes and communication skills
Before we dive in, I’d like to share these fascinating images from Dawood and de Bakker from the University of Amsterdam. Micro-CT captures of an ectopic removed by salpingectomy reveal wonderful details of embryonic development.
You can click here to watch a 1-minute 13-second video showing a 3D video render and my discussion about the role of the embryonic yolk sac.
Wishing you the best for the month we’re already almost halfway through.
Danny
Bowel Prep Before Surgery: All Pain, No Gain?
Mechanical bowel preparation (MBP) has been a staple in the preoperative regimen for various surgeries, including gynaecologic procedures. Historically, it has been posited that MBP helps in improving the surgical field view, facilitating bowel handling, and possibly reducing the risk of postoperative complications like surgical site infections. However, the empirical support for these perceived benefits has been mixed, leading to debates within the medical community about the necessity of MBP in benign laparoscopic or vaginal gynaecologic surgeries.
This research aims to evaluate the efficacy and safety of MBP in benign gynaecologic surgeries through a meta-analysis of 13 randomized clinical trials involving 1715 patients. The study found no significant benefits of MBP on surgical field view, bowel handling, or operative outcomes. Conversely, it demonstrated that MBP was associated with increased preoperative symptoms such as pain, weakness, hunger, insomnia, and lower patient satisfaction. Therefore, the review concludes that the routine use of MBP in benign gynaecologic surgeries should be reconsidered, particularly in light of the adverse effects observed.
The Sonopartogram
The article discusses the traditional method of assessing labour progress through digital vaginal examination and using a partogram, a graphical representation of labour that has remained mostly unchanged for a century. In recent years, the use of portable ultrasound machines in the delivery room has increased, leading to the concept of a sonopartogram, which offers greater accuracy in assessing fetal head position and could complement traditional methods. Includes technical guidance for intrapartum ultrasound.
Vacuum pop-offs and neonatal outcomes
This research was conducted in a large tertiary care centre with a moderate sample size of cases with three or more pop-offs (vacuum detachments), which allowed for a detailed analysis of possible outcomes. Potential intrapartum confounders were considered. The research found that having pop-offs during vacuum-assisted vaginal delivery (VAVD) increases neonatal risks. However, it did not establish a dose-dependent relationship between the number of pop-offs and adverse outcomes in newborns, confirming previous research.
Heat and pregnancy - a concerning link
The Lancet study explored the effects of heat stress on pregnant women in sub-Saharan Africa, specifically those in agriculture. It found that both maternal and fetal well-being were adversely affected by heat exposure. The odds of poor fetal outcomes increased with rising temperatures, as measured by the Universal Thermal Climate Index (UTCI).
The implications are global. Even in first-world countries with advanced healthcare, pregnant women may face similar risks due to climate change. The research calls for urgent, broader studies to understand the risks and develop interventions. In summary, this issue isn't confined to one region; it's a universal concern requiring updated health guidelines to protect pregnant women and their unborn children everywhere.
The incidence of anal incontinence following obstetric anal sphincter injury graded using the Sultan classification: a network meta-analysis
The incidence of anal incontinence following obstetric anal sphincter injuries is an ongoing clinical concern. Existing literature categorises these injuries according to the Sultan classification, ranging from grade 3a to fourth-degree tears. However, systematic comparisons of anal incontinence rates across these grades have been limited. Accurate diagnosis and grading are crucial for effective counselling and intervention strategies, given the potential for long-term functional impairment.
The study at hand is a network meta-analysis that scrutinises the incidence of anal incontinence across different grades of obstetric anal sphincter injury, using data from 10 studies involving 2,467 women. Results demonstrate a statistically significant higher incidence of anal incontinence with increasing tear grade; fourth-degree tears have the worst clinical outcomes. Notably, all studies reviewed had a high or unclear risk of bias in one or more assessed elements. This research underscores the clinical value of accurate grading and repair of obstetric anal sphincter injuries, as well as the need for high-quality studies to substantiate these findings.
Also included below are two other relevant studies.
Communicating with patients about surgery - how much should we guide treatment?
Harvard Business Review: The power of talk - Who gets heard and why
In a meeting focused on performance assessment at a large corporation, not a single woman was promoted due to a perceived lack of self-confidence in otherwise suitable candidates. The division head questioned this outcome, rightly so. Confidence is often assessed by one's own communication style, which is influenced by social and cultural factors.
Research in socio-linguistics shows that communication isn't straightforward; it's not just what you say but how you say it. Language is learned social behaviour, and our interpretation of confidence or competence may be biased by cultural experiences and norms. In a work setting, these learned speaking styles can greatly impact judgments on an individual's capability and self-assuredness.
It's crucial for doctors in and heading towards leadership positions to be aware that linguistic styles can vary greatly among team members due to cultural or gender differences. Making judgments based solely on these styles could result in overlooking highly competent individuals. These insights may help you make more informed and fair team evaluations.