ABSTRACT OBJECTIVE: To evaluate outcomes of a novel blend of techniques for treating vaginal contractures secondary to previous conventional constructive surgeries. STUDY DESIGN: Balloon vaginoplasty and scar tissue hydrolysis/hydro-disintegrations (BV/STH) were performed for three cases with vaginal scars after previously failed vaginoplasties. The outcomes measured were operative complications, vaginal depths as measured by a calibrated vaginometer, and functional outcomes as measured by changes in the penetration and satisfaction (P/S) scores on a 0-100 point visual analog scale. RESULTS: BV/STH was performed successfully for 3 women with previously failed vaginoplasties. They included a case with a previous partial thickness skin grafting, one with previous labial flaps and one with previous amnion membrane graft. Preoperative P/S scores ranged from 20 to 30 points. Initially BV was done in addition to multiple snips of the scar tissue with a 2mm scalpel. No operative complications were reported but we failed to achieve progressive increase in vaginal depth after day 4. Scar tissue was injected with a mixture of lidocaine and normal saline. Progressive increase in depth was dramatically improved after scar hydro-disintegration. The depths of the resultant neovaginas were 10, 11 and 11.6 cm. Postoperative P/S scores increased up to 90. CONCLUSIONS: BV/STH was successfully performed as a revision surgery for blind vaginas with fibrosis. This report highlights a wider range of possible applications of balloon vaginoplasty.

ABSTRACT OBJECTIVE: To evaluate outcomes of a novel blend of techniques for treating vaginal contractures secondary to previous conventional constructive surgeries. STUDY DESIGN: Balloon vaginoplasty and scar tissue hydrolysis/hydro-disintegrations (BV/STH) were performed for three cases with vaginal scars after previously failed vaginoplasties. The outcomes measured were operative complications, vaginal depths as measured by a calibrated vaginometer, and functional outcomes as measured by changes in the penetration and satisfaction (P/S) scores on a 0-100 point visual analog scale. RESULTS: BV/STH was performed successfully for 3 women with previously failed vaginoplasties. They included a case with a previous partial thickness skin grafting, one with previous labial flaps and one with previous amnion membrane graft. Preoperative P/S scores ranged from 20 to 30 points. Initially BV was done in addition to multiple snips of the scar tissue with a 2mm scalpel. No operative complications were reported but we failed to achieve progressive increase in vaginal depth after day 4. Scar tissue was injected with a mixture of lidocaine and normal saline. Progressive increase in depth was dramatically improved after scar hydro-disintegration. The depths of the resultant neovaginas were 10, 11 and 11.6 cm. Postoperative P/S scores increased up to 90. CONCLUSIONS: BV/STH was successfully performed as a revision surgery for blind vaginas with fibrosis. This report highlights a wider range of possible applications of balloon vaginoplasty.

ͣ ABSTRACT OBJECTIVE: To compare outcomes between elective delivery at 37 weeks of pregnancy and expectant management among pregnant women with mild to moderate chronic hypertension. METHODS: In a two-center study, 76 women with mild to moderate chronic hypertension were randomly allocated to planned delivery at 37 completed weeks (group A) or expectant management for spontaneous onset of labor or reaching 41weeks (group B) between April 2012 and October 2013. Differences were compared by t test, χ(2) test, or Fisher exact test. Odds ratios (ORs) with 95% confidence interval (CIs) were determined. RESULTS: There were no differences in superimposed pre-eclampsia (SPE), severe hypertension, preterm delivery, placental abruption, oligohydramnios, intrauterine growth restriction, or perinatal mortality between the groups. Group B had higher gestational age at delivery (P=0.001) and birth weight (P=0.01), but lower cesarean (OR 3.4; 95% CI, 1.2-10.3; P=0.03) and neonatal care unit admission (OR 5.4; 95% CI, 1.4-21.0; P=0.01) rates. More women with SPE were diagnosed before than after 37weeks in group B (P=0.01). Overall, patients who developed SPE had more adverse pregnancy outcomes than those who did not. CONCLUSION: Mild to moderate chronic hypertension could be managed expectantly up to 41weeks if SPE did not develop.

ͣ ABSTRACT OBJECTIVE: To compare outcomes between elective delivery at 37 weeks of pregnancy and expectant management among pregnant women with mild to moderate chronic hypertension. METHODS: In a two-center study, 76 women with mild to moderate chronic hypertension were randomly allocated to planned delivery at 37 completed weeks (group A) or expectant management for spontaneous onset of labor or reaching 41weeks (group B) between April 2012 and October 2013. Differences were compared by t test, χ(2) test, or Fisher exact test. Odds ratios (ORs) with 95% confidence interval (CIs) were determined. RESULTS: There were no differences in superimposed pre-eclampsia (SPE), severe hypertension, preterm delivery, placental abruption, oligohydramnios, intrauterine growth restriction, or perinatal mortality between the groups. Group B had higher gestational age at delivery (P=0.001) and birth weight (P=0.01), but lower cesarean (OR 3.4; 95% CI, 1.2-10.3; P=0.03) and neonatal care unit admission (OR 5.4; 95% CI, 1.4-21.0; P=0.01) rates. More women with SPE were diagnosed before than after 37weeks in group B (P=0.01). Overall, patients who developed SPE had more adverse pregnancy outcomes than those who did not. CONCLUSION: Mild to moderate chronic hypertension could be managed expectantly up to 41weeks if SPE did not develop.

ABSTRACT OBJECTIVE: To evaluate the impact of bilateral internal iliac artery ligation (BIL), bilateral uterine artery ligation (BUAL), step-wise uterine devascularization (SWUD), and B-Lynch on infertility, ovarian reserve, and pregnancy outcome. METHODS: The study included 168 infertile or pregnant patients-recruited at outpatient clinics in Egypt-who had previously undergone uterine-sparing surgery (BIL [group I], n=59; SWUD [group II], n=65); BUAL [group III], n=2; and B-Lynch [group IV], n=42). One-way analysis of variance was used to compare the prevalence of infertility, the status of ovarian reserve, and the prevalence and type of relevant maternal and/or fetal obstetric complications between the groups. RESULTS: Groups II and IV had the highest prevalences of infertility. The ovarian reserve was significantly lower in group II. Unexplained infertility was the predominant cause of infertility in group I, anovulation and premature ovarian failure in group II, and endometriosis and intrauterine adhesions in group IV. The frequency of obstetric complications, particularly placenta previa and preterm labor, was high in group IV. CONCLUSION: Of the 4 procedures, BIL had the least deleterious effect on reproductive performance; SWUD increased the risk of premature ovarian failure, and B-Lynch increased the risks of endometriosis, intrauterine adhesions, placenta previa, and preterm labor.