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There are few data on complications with gender affirming surgery. The aim of this study was to assess peri- and postoperative complications of laparoscopic hysterectomy and mastectomy performed in a single sitting in transgender men. Assessment of intra- and postoperative complications in a series of 65 transgender men (mean age 27, range 18–47) undergoing concomitant mastectomy and laparoscopic hysterectomy with salpingo-oophorectomy. Mean operating time was 292 ± 47 min. Thirty-four (52%) patients experienced complications: 28 (41%) DINDO grade I, 0 DINDO grade 2, 6 (11%) DINDO grade III. The six grade 3 complications consisted of 5 hematomas requiring evacuation after mastectomy and 2 vaginal tears requiring transvaginal repair. Three patients were readmitted within 30 days, all for postoperative bleeding/hematoma. In transgender men, performing laparoscopic hysterectomy and mastectomy at a single sitting has a modest rate of perioperative complications, and may improve resource utilization. Supplementary Information The online version contains supplementary material available at 10.1007/s43032-021-00724-x.

Preterm premature rupture of membranes (PPROM) occurs in up to 3% of all pregnancies. Only few comparative studies have investigated potential risks and benefits between different tocolytic substances in women with PPROM. The aim of this study was to compare the neonatal short term outcome after tocolysis with Atosiban or Hexoprenaline in women with PPROM. This is a retrospective observational cohort study of women with PPROM between 24 and 32 weeks of gestation comparing neonatal and maternal outcome after tocolysis with atosiban or hexoprenaline. Outcome parameters were short term neonatal outcome, maternal tocolytic efficacy, effectiveness and tolerability and neonatal neurodevelopmental long-term outcome. Continuous variables were compared using t-Test or Mann–Whitney U test, as appropriate. For categorical variables Chi-square after Pearson and Fisher exact-test were used to compare the two groups. 93 women were included into this study with 42 women receiving hexoprenaline and 51 women receiving atosiban as primary tocolytic treatment. Mean gestational age was 29 weeks in both groups at the time PPROM. No differences were found for any short term neonatal outcome parameters, tocolytic efficacy, effectiveness and tolerability and neonatal neurodevelopmental long-term outcome. Both hexoprenaline and atosiban do not affect the short and long term neonatal outcome in women with PPROM for the time of lung maturation.

To examine the association between third trimester cervical length (CL) measurement and duration of the first stage of labor. This prospective cohort study included women with a singleton pregnancy who had routine CL measurements taken by transvaginal ultrasonography between 37 and 39 weeks gestation. Subjective duration of the first stage of labor was defined as the duration of contractions that the women subjectively had from the onset of regular contractions to full effacement of the cervix. Objective duration of first stage of labor was defined as 3 cm cervical dilation independent of cervical effacement until full effacement of the cervix. Associations between variables were analyzed using nonparametric correlations coefficients. A model relating the duration of labor to predictors was built using linear regression. In this analysis a total of 129 women were included. There was no significant correlation between CL and subjective duration of labor (ρ = −0.037, p = 0.695); however, a reduction in CL increased the objective duration of the first stage of labor (ρ = −0.269, p = 0.013). In univariate analysis parity (p = 0.018), hypertensive disorders (p = 0.013) and induction of labor (p = 0.022) were significantly associated with subjective duration of the first stage of labor. A long cervix in the third trimester is not associated with a prolonged first stage of labor. Induction of labor and multiparity were associated with a shorter first stage of labor while hypertension was associated with a longer duration of labor.

ObjectiveThe Robson ten group classification system is used as a global standard for assessing, monitoring and comparing caesarean delivery (CD) rates within and between maternity services. Our objective was to compare the changes of CD rates at our institution between the years 2008-2010 and 2017-2019 using the Robson ten group classification system.Study designData was collected retrospectively and all women were classified using the obstetric concepts and parameters described in the Robson ten group classification system.ResultsDuring 2008-2010 7,832 deliveries were performed, increasing to 9,490 in 2017-2019. The CD rate also increased from 29.1% to 32.2% (pConclusionThe biggest contributors to the CD rate in our hospital remain multiparous women at term with a previous CD. The CD rates, as well as the overall size of this group, keep rising, resulting in a need to establish more effective ways to motivate women with one previous CD towards vaginal birth after caesarean delivery (VBAC). Furthermore, the CD rate in preterm deliveries is increasing and approaching 50%. This illustrates the need to discuss whether CD is the appropriate mode of delivery in half of the preterm infants.

Objective We investigated whether time of birth, unit volume, and staff seniority affect neonatal outcome in neonates born at ≥34+0 weeks of gestation. Design Population-based prospective cohort study. Setting Ten public hospitals in the Austrian province of Styria. Sample A total of 87 065 neonates delivered in the period 2004–2015. Methods Based on short-term outcome data, generalised linear mixed models were used to calculate the risk for adverse and severely adverse neonatal outcomes according to time of birth, unit volume, and staff seniority. Main outcome measures Neonatal composite adverse and severely adverse outcome measures. Results The odds ratio for severely adverse events during the night-time (22:01–07:29 hours) compared with the daytime (07:30–15:00 hours) was 1.35 (95% confidence interval, 95% CI 1.13–1.61). There were no significant differences in neonatal outcome comparing weekdays and weekends, and comparing office hours and shifts. Units with 500–1000 deliveries per year had the lowest risk for adverse events. Adverse and severely adverse neonatal outcomes were least common for midwife-guided deliveries, and became more frequent with the level of experience of the doctors attending the delivery. With increasing pregnancy risks, senior staff attending delivery and delivering in a tertiary centre reduce the odds ratio for adverse events. Conclusions Different times of delivery were associated with increased adverse neonatal outcomes. The management of uncomplicated deliveries by less experienced staff showed no negative impact on perinatal outcome. In contrast, riskier pregnancies delivered by senior staff in a tertiary centre favour a better outcome. Achieving a better balance in the total number of labour ward staff during the day and the night appears to be a greater priority than increasing the continuous presence of senior obstetrical staff on the labour ward during the out-of-hours period. Tweetable abstract Deliveries during night time lead to a greater number of neonates experiencing severely adverse events.

The new expert recommendation from the Austrian Society of Obstetrics and Gynaecology (OEGGG) comprises an interpretation and summary of guidelines from the leading specialist organisations worldwide (RCOG, ACOG, SOGC, CNGOF, WHO, NIH, NICE, UpToDate). In essence it outlines alternatives to the direct pathway to elective repeat caesarean section (ERCS). In so doing it aligns with international trends, according to which a differentiated, individualised clinical approach is recommended that considers benefits and risks to both mother and child, provides detailed counselling and takes the patientʼs wishes into account. In view of good success rates (60–85 %) for vaginal birth after caesarean section (VBAC) the consideration of predictive factors during antenatal birth planning has become increasingly important. This publication provides a compact management recommendation for the majority of standard clinical situations. However it cannot and does not claim to cover all possible scenarios. The consideration of all relevant factors in each individual case, and thus the ultimate decision on mode of delivery, remains the discretion and responsibility of the treating obstetrician.

In 2017, the Austrian Society for Paediatric and Adolescent Medicine (ÖGKJ) published a guideline on the primary care of premature infants at the limit of viability. In this guideline, it is recommended that a Caesarean section be preferred as mode of delivery with regard to an early preterm birth (22 + 0 - 24 + 6 weeks of pregnancy) due to an allegedly lower perinatal risk of cerebral haemorrhage. In contrast to this, the Austrian Society for Gynaecology and Obstetrics (OEGGG) considers there to be no clinical and scientific basis for this recommendation and the mode of delivery in the case of early preterm birth must be adapted to the individual maternal and foetal clinical situation. The international data available from the generally retrospective investigations show heterogeneous results regarding the mode of delivery. The prospective and randomised data in this regard are insufficient. A Cochrane analysis does not show any advantage in favour of a Caesarean delivery. The German-language guidelines (AWMF and Switzerland) make analogous recommendations for adapting the mode of delivery with regard to an early preterm birth individually to the respective clinical situation. In the case of an early preterm birth and a singleton in cephalic presentation, the OEGGG therefore recommends individual management of the delivery which takes the maternal and foetal clinical situation into account and also includes vaginal delivery as a mode of delivery in the clinical decision process.Im Jahr 2017 hat die Österreichische Gesellschaft für Kinder- und Jugendheilkunde (ÖGKJ) eine Leitlinie zur Erstversorgung von Frühgeborenen an der Grenze der Lebensfähigkeit veröffentlicht. In dieser Leitlinie wurde empfohlen, im Bereich der frühen Frühgeburt (22 + 0 – 24 + 6 SSW) aufgrund eines vermeintlich geringeren perinatalen Hirnblutungsrisikos als Entbindungsmodus eine Sectio caesarea zu präferieren. Im Gegensatz dazu ist die Österreichische Gesellschaft für Gynäkologie und Geburtshilfe (OEGGG) der Ansicht, dass es für diese Empfehlung keine klinische und wissenschaftliche Grundlage gibt und der Entbindungsmodus im Bereich der frühen Frühgeburtlichkeit der individuellen maternalen und fetalen klinischen Situation angepasst werden muss. Die internationale Datenlage der meist retrospektiven Untersuchungen zeigt heterogene Ergebnisse zu der Fragestellung des Entbindungsmodus. Prospektive und randomisierte Daten liegen nur unzureichend vor. Eine Cochrane-Analyse zeigt keinen Vorteil zugunsten der Schnittentbindung. Die deutschsprachigen Leitlinien (AWMF und Schweiz) kommen zu analogen Empfehlungen, den Entbindungsmodus im Bereich der frühen Frühgeburt individuell der jeweiligen klinischen Situation anzupassen. Die OEGGG empfiehlt deshalb im Bereich der frühen Frühgeburtlichkeit bei Einlingen in Schädellage ein individuelles Entbindungsmanagement, das die maternale und fetale klinische Situation berücksichtigt und auch eine Vaginalgeburt als Geburtsmodus in den klinischen Entscheidungsprozess einschließt.

Background Use of prenatal acupuncture for labor preparation is common, but there is still conflicting evidence with respect to its objective obstetric benefits. There is little information on women's expectations and subjective experiences with acupuncture treatments. Methods In this retrospective cohort study, a validated questionnaire on women's treatment satisfaction was sent to women who had received prenatal acupuncture at the obstetric clinic of the Medical University of Graz, Austria within the last 3 years. The electronic obstetric database was used to extract detailed clinical and obstetric data of women who received acupuncture and delivered at the hospital. For comparison, obstetric data were matched with a control group of women without prenatal acupuncture, who had given birth at the hospital during the study period. Results The questionnaire was sent to 150 women, out of which 70 (46.7%) completed and returned the questionnaire. Analysis of the questionnaire indicated good overall satisfaction (mean sum score 26.22 ± 4.72) with acupuncture treatment-97.1% indicated that they were very or quite satisfied. Responders did not differ from nonresponders, except for the time between delivery and questionnaire (P = .015). Comparisons between the deliveries after prenatal acupuncture (n = 144) and the matched control deliveries (n = 576) showed no statistical significant differences in the length of labor and use of analgesics. Conclusion Prenatal acupuncture is likely to have positive effects on pregnant women, aside from an objective influence on labor duration and pain.

Introduction Rates and routes of hysterectomy have implications for quality, costs and training. This study analyzed rates of benign hysterectomy and surgical approaches for benign hysterectomy in Austria from 2002 to 2014. Material and Methods This was a population-based retrospective observational study of coding data from all acute care hospitals (public and private) in Austria. Main outcome measures were numbers of women undergoing hysterectomy for benign indications in Austria per year and the route of hysterectomy for benign indications. Results The number of benign hysterectomies performed per year declined from 10 675 in 2002 to 7747 in 2014, a decline of 27%. The use of vaginal hysterectomy was stable (53% and 47%, respectively). Use of laparoscopic techniques increased (5% in 2002, 32% in 2014) whereas use of abdominal hysterectomy decreased (41% and 20%, respectively). Conclusions Numbers of benign hysterectomies performed per year in Austria declined substantially between 2002 and 2014. Use of vaginal hysterectomy was stable at about 50%, whereas increased use of laparoscopic techniques was associated with lower rates of open hysterectomy.

We analyzed outcome of women screened for preeclampsia with two different multifactorial risk algorithms (Predictor®Software by PerkinElmer, PerkinElmer, Waltham, MA; PERK-group: n = 214 and Viewpoint® by GE Healthcare, Dornstadt, Germany; VIEW-group: n = 209) in first trimester. Women at high risk for developing preeclampsia were advised to take low-dose acetylsalicylic acid (LDA). Screening positive rates for early onset preeclampsia differed significantly between the two groups (7.9% versus 26.3%; p = 0.000). According the clinical use of screening test criteria, LDA was prescribed in 63 (29.4%) women in the PE-group and 55 (26.3%) in the VP-group (p = 0.516). There were no differences in onset of preeclampsia [4 (1.9%) versus 6 (2.9%); p = 0.540]. No early or severe preeclampsia occurred in the whole population.

Background/Definition of the Problem: In recent years, postoperative management has changed towards rapid mobilisation, early oral feeding and rapid rehabilitation (known as Fast-Track or Enhanced Recovery Concepts). This study analysed the postoperative length of stay after vaginal hysterectomy in 3 different periods of time. Material and Methods: In the period October 2011 – September 2012, 75 patients underwent vaginal hysterectomies (± adnexectomy); another 114 vaginal or laparoscopic hysterectomies with additional operations (e.g. prolapse surgery and incontinence surgery) and malignancies were not included. The time periods August 1995 – July 1996 (n = 50) and October 1996 – September 1997 (n = 96) served as a comparison. Reducing the length of stay was not an explicit goal. Results: The median postoperative stay was shortened from 7 (5–9) to 5 (3–15) or 3 (0–5) days (p

Objective We investigated whether time of birth, unit volume, and staff seniority affect neonatal outcome in neonates born at ≥34+0 weeks of gestation. Design Population-based prospective cohort study. Setting Ten public hospitals in the Austrian province of Styria. Sample A total of 87 065 neonates delivered in the period 2004–2015. Methods Based on short-term outcome data, generalised linear mixed models were used to calculate the risk for adverse and severely adverse neonatal outcomes according to time of birth, unit volume, and staff seniority. Main outcome measures Neonatal composite adverse and severely adverse outcome measures. Results The odds ratio for severely adverse events during the night-time (22:01–07:29 hours) compared with the daytime (07:30–15:00 hours) was 1.35 (95% confidence interval, 95% CI 1.13–1.61). There were no significant differences in neonatal outcome comparing weekdays and weekends, and comparing office hours and shifts. Units with 500–1000 deliveries per year had the lowest risk for adverse events. Adverse and severely adverse neonatal outcomes were least common for midwife-guided deliveries, and became more frequent with the level of experience of the doctors attending the delivery. With increasing pregnancy risks, senior staff attending delivery and delivering in a tertiary centre reduce the odds ratio for adverse events. Conclusions Different times of delivery were associated with increased adverse neonatal outcomes. The management of uncomplicated deliveries by less experienced staff showed no negative impact on perinatal outcome. In contrast, riskier pregnancies delivered by senior staff in a tertiary centre favour a better outcome. Achieving a better balance in the total number of labour ward staff during the day and the night appears to be a greater priority than increasing the continuous presence of senior obstetrical staff on the labour ward during the out-of-hours period. Tweetable abstract Deliveries during night time lead to a greater number of neonates experiencing severely adverse events.

Objective To investigate whether knowledge of fetal outcome influences retrospective interpretation of cardiotocographic tracings and subsequent management recommendations. Design Prospective online study. Setting Seven university hospitals in five European countries. Population Forty-two intrapartum tracings from women with singleton pregnancies and uneventful antepartum courses. Methods Using an online questionnaire, 123 healthcare professionals interpreted 42 tracings without any knowledge of fetal outcome and provided management recommendations according to the National Institute of Clinical Excellence guidelines (intrapartum care). Two months later, 93 of the 123 participants re-interpreted the same re-ordered tracings, this time with information on the newborn's umbilical artery pH. Outcome measures Comparison of the evaluation of tracing features, overall tracing classification, and management recommendations between the initial analysis and re-interpretation. Results In newborns with umbilical artery pH ≤ 7.05, knowledge of the pH value led to significant changes in the evaluation of all basic tracing features. In this group, classification of tracings as ‘normal’ decreased 76% (8.8–2.1%, P < 0.001), whereas classification as ‘pathologic’ increased 51% (44.7–67.5%, P < 0.001). In newborns with pH 7.06–7.19, classification of tracings as ‘normal’ decreased 36% (22.4–14.4%, P < 0.001), and in those with pH ≥ 7.20, classification of tracings as ‘pathologic’ decreased 40% (23.4–14.1%, P < 0.001). In the group of newborns with umbilical artery pH ≤ 7.05, the recommendations ‘no attention needed’ decreased 75% (10.2–2.6%, P < 0.001), and the number of recommendations ‘rapid reversal of hypoxic cause or immediate delivery’ increased 70.3% (42.1–71.7%, P < 0.001). Conclusions When provided with information on adverse fetal outcome, healthcare professionals provide a more pessimistic evaluation of basic tracing features, overall classification, and clinical management recommendations. Tweetable abstract Knowledge of adverse fetal outcome leads to more pessimistic CTG evaluation and management recommendations.

Das Erkennen eines suspekten oder pathologischen CTGs lasst keine sichere Aussage uber das tatsachliche Vorliegen eines „fetal distress“, bzw. das Ausmas der fetalen Blutgas-u. pHWert-Veranderungen zu. Ohne den Einsatz der Mikroblutuntersuchung muss das Auftreten von suspekten oder pathologischen CTG-Veranderungen haufig eine raschest mogliche Geburtsbeendigung mittels vaginal-operativer Masnahme oder Kaiserschnitt nach sich ziehen. Diese Studie soll prufen, wie viele Kaiserschnitte und vaginal-operative Entbindungen durch den Einsatz von Mikroblutuntersuchungen (MBU) bei suspekten oder pathologischen Geburts-CTGs in der klinischen Realitat verhindert werden konnen. Retrospektive Analyse des Geburtsmodus mittels deskriptiver Statistik an 669 Patientinnen im Zeitraum 2008–2009, bei denen bei suspektem oder pathologischem CTG eine Mikroblutuntersuchung durchgefuhrt wurde. Auserdem sollte untersucht werden, ob eine Abhangigkeit der MBU-Verteilung vom Gestationsalter besteht. Durch den Einsatz der Mikroblutuntersuchung konnte bei 6,4% der im Studienkollektiv eingeschlossene Patientinnen mit suspektem oder pathologischem CTG, durch einen oder mehrere MBU-Werte im Normbereich, eine operative Entbindung umgangen und eine Spontangeburt ermoglicht werden. Weiters zeigt sich eine Haufung der Mikroblutuntersuchungen bei Gestationsaltern jenseits des Geburtstermins. Die fetale Mikroblutuntersuchung stellt ein effektives Hilfsmittel im geburtshilflichen Management dar und kann zur Reduktion der operativen Entbindungsrate beitragen. Das Risiko der Invasivitat des Eingriffs kann im Vergleich zur Reduktion der operativen Entbindungsrate als gering angesehen werden. Die Bereitschaft zur Durchfuhrung von Mikroblutuntersuchungen steigt mit Fortschreiten des Gestationsalters offensichtlich stetig an.

Objective Bartholin's cysts and abscesses occur in about 2% of women. None of the surgical or conservative treatment approaches have been proven to be superior. The Word catheter is an outpatient treatment option, but little is known about aspects of implementing this therapy in an office setting. The present study's focus is on recurrence rates and organizational requirements of implementing outpatient treatment of Bartholin's cyst and abscess and compares costs of Word catheter treatment and marsupialization. Study design Between March 2013 and May 2014 30 women were included in the study. We measured time consumed for treatment and follow-up and analyzed costs using the Word catheter and marsupialization under general anesthesia. We also assessed the ease of use of the Word catheter for application and removal using a standardized visual analog scale (VAS 1–10). Results Word catheter treatment was successful in 26/30 cases (87%). Balloon loss before the end of the 4-week treatment period occurred in 11/26 cases with a mean residence time of 19.1 (±10.0) days. None of the patients with early catheter loss developed recurrent cyst or abscess. Recurrence occurred in 1/26 cases (3.8%). Difficulty-score of application was 2 [1] , [2] , [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] and of removal 1 [1] , respectively. Costs were € 216 for the treatment in the clinic as compared with € 1584/€ 1282 for surgical marsupialization with a one-night stay or daycare clinic, respectively. Conclusions The present study indicates that the Word catheter is an easy to handle, low cost outpatient procedure with acceptable short-term recurrence rates. Treatment costs are seven times lower than for marsupialization.

BACKGROUND Although fetal blood sampling for pH is well established the use of lactate has not been widely adopted. This study validated the performance and utility of a handheld point-of-care (POC) lactate device in comparison with the lactate and pH values obtained by the ABL 800 blood gas analyzer. METHODS The clinical performance and influences on accuracy and decision-making criteria were assessed with freshly taken fetal blood scalp samples (n=57) and umbilical cord samples (n=310). Bland-Altman plot was used for data plotting and analyzing the agreement between the two measurement devices and correlation coefficients (R²) were determined using Passing-Bablok regression analysis. RESULTS Sample processing errors were much lower in the testing device (22.8% vs. 0.5%). Following a preclinical assessment and calibration offset alignment (0.5 mmol/L) the test POC device showed good correlation with the reference method for lactate FBS (R²=0.977, p

Analysis of the impact of non-reassuring foetal heart rate patterns (FHR) and suspected foetal distress during active labour on the neonatal outcome in diabetic compared to non-diabetic mothers.Retrospective case-control study comparing the short-term neonatal outcome including Apgar score at 5 min, and arterial/venous umbilical cord blood pH of 57 deliveries of women with different types of diabetes and 114 healthy controls. Patients were selected out of all deliveries with suspected foetal distress during active labour and performed foetal scalp pH samplings (n = 590) at the Medical University of Graz, Austria, during 2008-2009.Arterial pH was significantly lower in the diabetic group (7.215 versus 7.250, p = 0.007). Apgar scores ( 8) at 5 min were similar in both groups (96.5% versus 95.6%, p = 0.566). The percentage of cases with foetal scalp blood pH7.25 was higher in the diabetes group, but did not reach statistical significance (14.1% versus 7.1%, p = 0.166).Newborns of women with gestational and type 1 diabetes and non-reassuring FHR tracing have significantly lower arterial cord blood pH values without consequences on neonatal postpartum adaptation. Special attention to pathological changes in FHR patterns and to the more rapid decline in foetal pH during periods of foetal distress may be warranted in women with gestational and pre-conceptional diabetes during active labour. More frequent foetal scalp pH testing to rule out clinically relevant foetal acidosis needs to be discussed.

Objective To evaluate the efficacy of misoprostol in the treatment of missed or incomplete abortion in relation to uterine position. Methods In a retrospective cohort study, misoprostol was evaluated as first-line treatment for missed and incomplete abortion before 13 gestational weeks. Between 2009 and 2011, women received 600 μg of sublingual misoprostol for missed abortion or 400 μg for incomplete abortion. Follow-up examinations were performed 7–10 days later, with the option of a second administration of misoprostol. Success was defined by the absence of vaginal bleeding or sonographic signs of incomplete abortion, and falling levels of β-human chorionic gonadotropin. Results In total, 111 women were included in the study. A single-dose regimen was effective for 73 (65.8%) women. The overall success rate, including repeat doses, was 73.0% (81/111). There were no significant differences in treatment success between women with missed abortion and those with incomplete abortion (56/89 [62.9%] vs 18/22 [81.8%]; P = 0.152). Anteverted uterine position was associated with significantly higher success rates compared with diverging position (62/86 [72.1%] vs 4/18 [22.2%]; P = 0.001). Conclusion Misoprostol is an effective treatment for early pregnancy failure. Uterine position might impact the success of medical treatment for missed abortion.

Objective We sought to test the hypothesis that an extraperitoneal cesarean section (ECS) technique reduces postoperative pain without increasing intraoperative and postoperative complications. Study Design In a single-center, single-blinded prospective trial we randomized 54 patients with an indication for primary or first repeat cesarean section at term pregnancy to an ECS (n = 27) or transperitoneal cesarean section (TCS) (n = 27) procedure. Patients with suspected abnormal placentation, a history of >1 cesarean section, or major abdominal surgery were excluded. The primary endpoint of the study was maximum abdominal pain measured by numeric rating scale ranging from 0–10. Results Patients after ECS had significantly less maximum surgical site pain than patients after TCS. Median peak pain scores on postoperative day 1 were 4.00 (interquartile range, 3.00–5.00) for ECS and 5.00 (interquartile range, 4.00–7.00) for TCS, respectively ( P = .031). Analgesic requirements, intraoperative nausea, and postoperative shoulder pain were significantly less after ECS. Overall operative time was significantly shorter in ECS, with no difference in delivery time. No bladder injury occurred in either group. There were no differences in estimated blood loss and neonatal outcome. Urogenital distress, urinary tract infection, and bowel dysfunction did not differ at discharge from hospital and 6 weeks after. Conclusion An extraperitoneal approach to cesarean section appears to reduce postoperative pain, usage of analgesics, and intraoperative nausea without an increase in significant complications.

Objective To present a case of an acute hemoperitoneum caused by a ruptured ovarian cyst in a late twin pregnancy. Design Case report study. Setting Department of Obstetrics and Gynecology, Medical University of Graz, Austria. Patient(s) A woman with a history of surgery for endometriosis and currently pregnant with dichorionic twins after IVF presented with acute abdominal pain. Intervention(s) Serial ultrasound assessment revealed a massive hemoperitoneum that was caused by a ruptured endometriotic ovarian cyst. Emergency laparotomy was performed. Main Outcome Measure(s) Hemostasis. Result(s) Laparotomy led to operative hemostasis and preterm cesarean section of healthy twins at 27 weeks of gestation. Conclusion(s) Endometriosis occurs in about 10% of women of reproductive age and carries an infertility rate of up to 50%. Severe endometriosis used to be a rare event in patients with spontaneously conceived pregnancies. However, during the last decade, the increased use of assisted reproductive technologies has led to higher fertility rates in patients with endometriosis and to a higher incidence of multiple gestations. Therefore, the number of pregnant women with endometriosis and associated complications may rise.