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Objective To determine if breastfeeding outcomes differ between mothers who conceived spontaneously compared with those who conceived with assisted reproductive technology (ART). Design Matched case-control study. Setting Teaching hospital. Patient(s) Ninety-four women having a singleton baby conceived with ART, matched by maternal age, parity, mode of delivery, and gestational age to controls who conceived spontaneously. Intervention(s) Cases and controls were interviewed using a standardized, structured questionnaire, to obtain information on lactation. Exposure to maternity care practices contributing to breastfeeding success was investigated. Main Outcome Measure(s) Initiation, exclusivity, and continuation of breastfeeding. Result(s) Cases were as likely as controls to initiate breastfeeding (89.4% vs. 90.4%), but by 6 weeks postpartum, a greater proportion of mothers who conceived through ART has ceased breastfeeding (20.2% vs. 5.3%). The percentage of mothers who exclusively breastfed their child for 6 months was similar among the 2 groups. On univariate conditional logistic regression, a history of using ART was the only predictor of early breastfeeding cessation (odds ratio=65.3 [95% confidence interval: 1.5–2889.3]). Conclusion(s) Women who have conceived with ART should be regarded as being at higher risk for early breastfeeding cessation. This study serves as a first step in the investigation of potential modifiable factors that contribute to breastfeeding failure among women who give birth after using ART, and may help in efforts to customize breastfeeding support strategies.

Objective To investigate whether women who conceive after assisted reproductive technology (ART) are at higher risk for emergency peripartum hysterectomy. Design A case–control study using a prospectively maintained institutional database. Setting A tertiary referral university teaching maternity hospital. Patient(s) Thirty-one women who underwent peripartum hysterectomy for management of hemorrhage, and 19,902 control women. Intervention(s) None. Main Outcome Measure(s) Association between potential predictors and peripartum hysterectomy. Result(s) The incidence of peripartum hysterectomy was 1.7 cases per 1,000 births (95% confidence interval [CI] 1.2–2.4). After adjustment for maternal age and twin pregnancy, placenta previa (odds ratio [OR] 50.78, 95% CI 23.30–110.68), prior cesarean delivery (OR 6.72, 95% CI 2.99–15.09 for one cesarean; OR 6.80, 95% CI 1.45–31.90 for two or more cesareans), previous myomectomy (OR 24.59, 95% CI 6.70–90.19), and ART conception (OR 5.98, 95% CI 2.18–16.40) were all antenatal predictors for peripartum hysterectomy. In women having a peripartum hysterectomy, 13.4% of the risk is attributable to mode of conception. Conclusion(s) A history of ART increases the likelihood of needing a peripartum hysterectomy to control hemorrhage. Further investigation is needed to determine whether ART conception should be included in algorithms of risk stratification for emergency cesarean hysterectomy and plan of care be modified accordingly.

Objective To evaluate the adequacy of laparoscopic ureterolysis as a primary treatment option for ureteral endometriosis. Design Prospective collaborative cohort study. Setting Gynecologic departments of three university hospitals. Patient(s) Women with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis on preoperative intravenous pyelography. Intervention(s) Laparoscopic ureterolysis. Main Outcome Measure(s) Cure rate, disesase recurrence. Result(s) Thirty-three patients underwent laparoscopic ureterolysis during the study period. Bilateral involvement of ureters was found in 4 (12.1%) cases. In women with unilateral lesions the left ureter was more frequently affected (24/29 vs. 5/29). Ureteral involvement was associated with uterosacral ligaments endometriosis in 65.5% (22/34) of cases. No inadvertent ureteral injuries occurred during ureterolysis. A partial wall resection of the ureter was necessary in one case and a segmental ureteral resection with vescicopsoas hitch was required in a women with intrinsic ureteral endometriosis. The median (range) follow-up time was 16 months (range: 3–53 months). Thirty-two patients (96.7%) had a patent ureter on the 3-month postoperative intravenous pyelography. The recurrence rate of ureteral lesions was 12.1% (4/33). Conclusion(s) Our findings suggest that a conservative laparoscopic approach is an effective treatment option in most patients with ureteral endometriosis exhibiting moderate-to-severe hydronephrosis.

Objective To evaluate the impact of deep endometriosis (DE) on bladder function, focusing on detrusor pattern, in patients without preoperative urinary symptoms. Design Prospective study. Setting Academic research center. Patient(s) A total of 25 asymptomatic patients: 12 patients with DE (group 1) and 13 patients with ovarian endometriosis (group 2, control group). Intervention(s) Preoperative urodynamic evaluation. Main outcome measure(s) The impact of DE on urodynamic parameters. Result(s) For the first time, a urodynamic diagnosis of detrusor overactivity was correlated with the presence of deep infiltrating endometriosis (group 1, 91.7% [11/12] vs. group 2, 7.7% [1/13]). All involuntary detrusor contractions were detected only during the filling phase. All cystometry parameters were found to be altered in group 1 and statistically different between the two groups. No pressure/flow study parameter significantly differed between the two groups, besides maximal detrusor pressure (46 cmH2O [33-79] vs. 29 cmH2O [15-40]), which was significantly higher in group 1. Therefore, all detrusor-related parameters are statistically different between the two groups. Postvoid residual does not reach a statistically significant difference. Conclusion(s) DE could significantly impair detrusor functions. A preoperative urodynamic evaluation allows the attainment of important functional information, even in asymptomatic patients.

Objective To evaluate perioperative details, long-term outcomes, and postsurgical fertility in case of laparoscopic ureterolysis for deep endometriosis. Design Retrospective analysis of prospectively collected data. Setting Academic research center. Patient(s) One hundred nine consecutive women who underwent laparoscopic ureterolysis for deep endometriosis. Intervention(s) Laparoscopic excision of ureteral endometriosis (ureteral shaving was attempted in all cases). Main Outcome Measure(s) Perioperative details, long-term outcomes, fertility rates, and need for secondary surgery, stratifying on presence/absence of hydronephrosis. Predictors of longer operative time, pain recurrence, and fertility were also investigated. Result(s) No conversion to open surgery was necessary. Intraoperative ureteral injury occurred in one case (0.9%). Nine women (8.3%) underwent ureteral stenting. Eight cases (7.3%) of mild postoperative complications were registered; no case of severe complications or postoperative ureteral fistula occurred. An increase was observed in the risk of short-/long-term adverse outcomes, according to the grade of preoperative hydronephrosis. Of the 80 women with available follow-up data, secondary ureteral procedures were necessary in 5 women (6.3%), whereas 22 patients (27.5%) had recurrence of endometriosis symptoms. Among the 36 women who wished to conceive, a total of 26 pregnancies were registered in 20 women (55.6%). The miscarriage rate was 15.6%. Hydronephrosis grade ≥2 was independently associated with longer operative time and higher rate of symptoms recurrence. Adjuvant hormonal therapy after ureterolysis was the only independent factor associated with lower fertility rates. Conclusion(s) Laparoscopic ureterolysis is a safe procedure, with encouraging pregnancy rates and satisfactory long-term results. However, hydronephrosis grade ≥2 is associated with worse outcomes.