Of 30 Kelly patients without urinary diversion 21 (70%) were completely or partially continent. Of the 30 patients 17

voided spontaneously without clean intermittent catheterization or augmentation, of whom 12 (71%) were continent. Lower abdominal appearance was graded as abnormal in 11 of 12 male Kelly patients vs in 2 of 7 nonKelly males with pubic approximation (p=0.01). Of the 12 females assessed none of 9 Kelly selleck chemicals patients had prolapse, whereas 2 of 3 nonKelly patients had prolapse (p<0.05).

Conclusions: The continence rate after the Kelly operation compares favorably with that in recent series. The abnormal appearance of the lower abdomen and bony pelvis in Kelly males may result from a lack of pubic approximation. Importantly pelvic organ prolapse may be decreased in women after the Kelly technique.”
“BACKGROUND

It has been hypothesized that internal tocodynamometry, as compared with external monitoring, may provide a more accurate assessment of contractions and thus improve the ability to adjust the dose of oxytocin effectively, resulting in fewer operative deliveries and less fetal distress. However, few data are available to test this hypothesis.

METHODS

We performed a randomized, controlled trial in six hospitals in the Netherlands to compare internal tocodynamometry with external monitoring

of uterine activity in women for whom induced or augmented labor was required. The primary outcome was the rate of operative deliveries, including SBI-0206965 purchase both cesarean sections and instrumented vaginal deliveries. Secondary outcomes included the use of antibiotics during

labor, time from randomization to delivery, and adverse neonatal outcomes (defined as any of the following: an Apgar score at 5 minutes of less than 7, umbilical-artery pH of less than 7.05, and neonatal hospital stay of longer than 48 hours).

RESULTS

We randomly assigned 1456 women to either internal tocodynamometry (734) check details or external monitoring (722). The operative-delivery rate was 31.3% in the internal-tocodynamometry group and 29.6% in the external-monitoring group (relative risk with internal monitoring, 1.1; 95% confidence interval [CI], 0.91 to 1.2). Secondary outcomes did not differ significantly between the two groups. The rate of adverse neonatal outcomes was 14.3% with internal monitoring and 15.0% with external monitoring (relative risk, 0.95; 95% CI, 0.74 to 1.2). No serious adverse events associated with use of the intrauterine pressure catheter were reported.

CONCLUSIONS

Internal tocodynamometry during induced or augmented labor, as compared with external monitoring, did not significantly reduce the rate of operative deliveries or of adverse neonatal outcomes. (Current Controlled Trials number, ISRCTN13667534; Netherlands Trial number, NTR285.