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PubMed2000

[Endoscopic surgery in obstetrics and gynecology].

There are three types of endoscopic surgery in obstetrics and gynecology: laparoscopy; hysteroscopy; and salpingoscopy. The main indications for laparoscopic surgery are myoma uteri, ovarian tumors, ectopic pregnancy, infertility, and endometriosis. Currently the indications are limited to benign disease. The main indications for hysteroscopic surgery are submucous myoma uteri, uterine anormalies, and Asherman syndrome. During hysteroscopy the uterine cavity is dilated with liquid and then a resectoscope or hysterofiberscope is used. Salpingoscopy is useful in examining the tubal cavity and a potent tool for tubal recanalization. Endoscopic surgical techniques will develop rapidly in the near future to serve the various needs of female patients.

Endometriosis↗
PubMed1992

[Lesions of the ureter in obstetric-gynecologic surgery].

The chapter of injuries to the ureter during obstetric-gynaecological surgery continues to be ignored in the literature published over the last decades, in spite of its prevalence in the practice. This has motivated our review and update of this issue. The interest of urological diagnostic procedures prior to surgery and conduit examination at any time during the operation exert some influence on the prevention of this pathology. Preoperative finding and reconstruction lead to better results, which benefit from the use of the urinary route, thus leaving the gut route and self-transplantation for exceptional situations. A new iatrogenic pathology has emerged from the most frequent use of gynaecological endoscopic surgery.

Endoscopy↗
PubMed1982

Suture materials currently used in obstetric-gynecologic surgery in the United States: a questionnaire survey.

Questionnaires on the material and the size of sutures used in obstetric-gynecologic surgery were sent to the directors of 110 residency programs in the specialty in medical schools in the United States. Replies were received from 80 (73%) programs. The findings indicate that the use of chromic catgut still predominates, but that the newer synthetic absorbable materials such as polyglycolic acid and polyglactin 910 are becoming popular for some procedures, including certain steps in abdominal closure and in reconstructive tubal surgery. The increasing use of these materials for hysterectomy and cesarean section, heretofore exclusively the domain of chromic catgut, suggests that there is possibly under way a reorientation of attitudes about the materials used for sutures in obstetric-gynecologic surgery. The characteristics of catgut and of synthetic absorbable materials are herein described and compared in relation to their current use.

Abdomen↗
PubMedDate not supplied

[Surgical cardiopathies and pregnancy (a 30-year report)].

The advent of heart-surgery in obstetrics has been determinant, in as much as it has improved therapeutic treatment and above all it has resulted in achievement which were impossible 30 years ago. The concepts already put forward by the school of cardio-obstetric surgery of Turin on haemodynamics in pregnancy and childbirth as biologic risk factors for the patient with a bad heart continue to be upheld. The results of Actis Dato Group's in cardiac surgery are reported. Almost all types of congenital and acquired cardiopathies in their relationships to pregnancy are described. 1750 Pregnancy cases in 997 heart diseased women are analised. The cooperation with the obstetrical team is stressed.

Adolescent↗
PubMed2000

Etiology, prognosis, and outcome of post-operative acute renal failure.

A Multivariate analysis was done in all patients who developed post operative ARF, during the period 1990-1995 to determine the etiological spectrum and to identify various variables affecting the outcome. Of 140 patients (110 operated at SGPGI and 30 operated outside) 116 underwent elective surgery. The different types of surgery leading to ARF were urosurgery (3.5%), open heart surgery (32.9%), gastrosurgery (16.4%), pancreatic surgery (9.3%), obstetrical surgery (3.6%) and others (2.8%). The incidence of ARF in SGPGI patients was highest in pancreatic surgery group (8.2%) followed by open heart surgery (3%). The different etiological factors responsible for ARF were perioperative hypotension (67.1%), sepsis (63.6%) and exposure to nephrotoxic drugs (29.3%). Sixty-four patients (45.7%) required dialysis. The overall mortality was 45%. The mortality was highest in patients who underwent open heart surgery (89.1%) followed by pancreatic surgery (84.6%). The factors associated with high mortality, other than the type of surgery, were preoperative hypotension (p < 0.05), oliguria (p < 0.01), need for dialysis (p < 0.05) and multiorgan failure (p < 0.001). AM following emergency surgery had poor outcome, though not statistically significant. Perioperative sepsis (p < 0.05) and preoperative use of aminoglycoside (p < 0.05) were significantly higher in patients operated outside SGPGI. This was associated with higher incidence of ARF. Thus we conclude that presence of multiorgan failure, oligoanuria, preoperative hypotension and need far dialysis are poor prognostic markers in ARF following surgery.

Acute Kidney Injury↗
PubMed2003

Wound endometriosis: risk factor evaluation and treatment.

BACKGROUND: Wound endometriosis is still a rare phenomenon. In this study, we tried to identify its risk factors and presented our experience in managing such disease. METHODS: We studied twenty-three women with pathologically confirmed wound endometriosis after surgery between January 1990 and June 1999 retrospectively. RESULTS: Patients were classified to three groups according to the types of operations including obstetric surgery (n = 6186), gynecologic surgery (n = 3231) and laparoscopic procedures (n = 2184), which made a significant difference in the occurrence rate of endometriosis (p = 0.04): 2.7 per 1000 obstetric surgeries, 1.5 per 1000 cases of gynecologic surgeries, and 0.5 per 1000 laparoscopic procedures. Obstetric surgery showed the relative risk of occurrence of wound endometriosis 7.71 (95%: 1.03-57.92) compared with laparoscopic procedures. The median time for occurrence of wound endometriosis in patients with normal preoperative CA-125 (< 15 mIU/ml), 760 days, was significantly longer than that in patients with abnormal preoperative CA-125 (> 15 mIU/ml) of 496 days (p = 0.03). Preoperative CA-125 level, patient's age, preoperative extent of endometriosis, or operative time made no significant contributions to the occurrence of wound endometriosis. Combination therapy of surgical excision and postoperative adjuvant therapy of GnRH-agonist or Danazol showed the better prognosis because it could decrease the recurrence of wound endometriosis (42.9% versus 11%, p = 0.01). CONCLUSION: Obstetric surgery may be an important risk factor in contributing to wound endometriosis, and the aggressive behavior of endometriosis itself might also be a possible risk factor because it shortens the time of occurrence of wound endometriosis after surgery. Therapy might be dependent on individuals. Surgical excision with postoperative adjuvant therapy of either GnRH-agonist or Danazol might be valid, although its effectiveness needed proven in the future.

Adult↗
PubMed2006

Venous thromboembolism prevention in surgery and obstetrics: clinical practice guidelines.

BACKGROUND AND OBJECTIVE: To produce up-to-date clinical practice guidelines on the prevention of venous thromboembolism in surgery and obstetrics. METHODS: A Steering Committee defined the scope of the topic, the questions to be answered, and the assessment criteria. Eight multidisciplinary working groups (total of 70 experts) performed a critical appraisal of the literature in the following disciplines: pharmacology of antithrombotic agents, orthopaedics; general surgery (gastrointestinal (GI) and varicose vein surgery); urology; gynaecology and obstetrics; thoracic, cardiac and vascular surgery; surgery of the head, neck and spine; and surgery of burns patients. The resultant reports and guidelines were submitted for comment and completion of the Appraisal of Guidelines Research & Evaluation questionnaire to a total of 150 peer reviewers, before producing definite guidelines. RESULTS: The report answers the following questions for each type of surgery: (i) What is the venous thromboembolism incidence according to clinical and/or paraclinical criteria in the absence of prophylaxis? (with stratification of venous thromboembolism risk into low, moderate and high categories); (ii) What is the efficacy and safety of the prophylactic measures used? (iii) When should prophylaxis be introduced and how long should it last? (iv) Does ambulatory surgery affect efficacy and safety of prophylaxis? CONCLUSIONS: Apart from answering the above questions, the guidelines provide a summary table for each discipline. This table stratifies types of surgery into the three risk categories, specifies the recommended prophylaxis for venous thromboembolism (pharmacological and/or mechanical) and grades each recommendation. In addition, whenever appropriate, the recommended prophylaxis is adjusted to low- and high-risk patients.

Anticoagulants↗
PubMed2001

Function of the upper limb after surgery for obstetric brachial plexus palsy.

We reviewed a consecutive series of 33 infants who underwent surgery for obstetric brachial plexus palsy at a mean age of 4.7 months. Of these, 13 with an upper palsy and 20 with a total palsy were treated by nerve reconstruction. Ten were treated by muscle transfer to the shoulder or elbow, and 16 by tendon transfer to the hand. The mean postoperative follow-up was 4 years 8 months. Ten of the 13 children (70%) with an upper palsy regained useful shoulder function and 11 (75%) useful elbow function. Of the 20 children with a total palsy, four (20%) regained useful shoulder function and seven (35%) useful elbow function. Most patients with a total palsy had satisfactory sensation of the hand, but only those with some preoperative hand movement regained satisfactory grasp. The ability to incorporate the palsied arm and hand into a co-ordinated movement pattern correlated with the sensation and prehension of the hand, but not with shoulder and elbow function.

Arm↗
PubMed2006

Role of intraoperative neurophysiology in primary surgery for obstetrical brachial plexus palsy (OBPP).

OBJECTIVE: Management of conducting neuroma-in-continuity in primary surgery for obstetrical brachial plexus palsy (OBPP) is still discussed controversially. We present our experience with intraoperative neurophysiological recordings in the management of lesions in continuity in OBPP. METHODS: A series of ten children with lesions in continuity of the upper brachial plexus is presented. Due to recordable compound nerve action potentials (CNAPs) and muscle response to motor stimulation across the neuroma, five children underwent external neurolysis of neuroma only (neurolysis group). Due to lack of recordable CNAPs or muscle response, resection of neuroma and interpositional nerve grafting were performed in another five children (resection and grafting group). Functional recovery after at least 30 months of follow-up was assessed. RESULTS: There was a marked difference in functional recovery between the neurolysis and the resection and grafting group. Especially, recovery of shoulder function was disappointing after external neurolysis of conducting neuroma-in-continuity. At the end of follow-up, results of shoulder and elbow function after resection of neuroma followed by interpositional nerve grafting were better without exception. CONCLUSION: Intraoperative neurophysiological recordings face certain difficulties when used in small children with OBPP. Due to overoptimistic assessment of prognosis after intraoperative CNAP recordings and motor stimulation, the functional results after neurolysis of conducting neuroma-in-continuity are disappointing. Resection of neuroma-in-continuity, conducting or not, offers the best opportunity for maximal functional recovery of the compromised upper limb in OBPP. The role of intraoperative neurophysiological techniques should be confined to the diagnosis of root avulsions.

Adolescent↗
PubMed2004

[Early results of nerve surgery in obstetrical brachial plexus palsy].

OBJECTIVES: To present surgical techniques and early postoperative results of patients who underwent nerve surgery for obstetrical brachial plexus palsy. METHODS: Twenty-four infants (12 girls, 12 boys; mean age 7.9 months; range 4 to 14 months) with obstetrical brachial plexus palsy underwent nerve repair following a surgical algorithm that showed inadequate spontaneous nerve regeneration and muscle function. Neurolysis was performed in five cases, intraplexial neurotisation in 17 cases, and extraplexial transfer of the spinal accessory nerve to the suprascapular nerve in seven cases. Seventeen patients (70%) had total palsy (C5, C6 and/or C7 rupture and C8, T1 avulsion), four patients (17%) had C5, C6 involvement, and three patients (13%) had C5-7 involvement. Pre- and postoperative evaluations were made according to the grading system of the Hospital for Sick Children (HSC). The mean follow-up period was 15.8 months (range 8 to 31 months). RESULTS: The mean HSC grades of the patients followed at least for 12 months were as follows: shoulder abduction 4, elbow flexion 4.5, wrist extension 2.3, and finger flexion 3.3. Compared to patients who underwent neurolysis alone, improved nerve regeneration was noted in patients who underwent neuroma excision and nerve grafting. No severe complications occurred postoperatively, including respiratory problems, metabolic acidosis, and hypothermia. CONCLUSION: Early diagnosis and nerve surgery in patients having insufficient muscle activity and requiring surgical intervention may prevent atrophy of the muscles and provide a more functional upper extremity.

Birth Injuries↗
PubMed1993

Acquired bleeding disorders: bleeding in obstetrics and surgery.

Hemorrhage continues to be the leading cause of maternal mortality and morbidity throughout the world. In England and Wales from 1970-87 hemorrhage, including ectopic pregnancy, was a major factor in over 40 maternal deaths. In the majority of deaths the care was substandard. In 70% of obstetric deaths from hemorrhage defective hemostasis contributes to the bleeding. Inappropriate correction of hypovolemia, failure to recognise and treat coagulation failure, and failure to control traumatic bleeding are the main causes of preventable death. In developing countries, cross matched blood and blood products may not be readily available. Surgical intervention should be preceded or accompanied by correction of the hemostatic defect with fresh frozen plasma and if necessary platelet concentrates. Teamwork with experienced staff is the essence of successful management of severe hemorrhage in obstetrics and surgery. A protocol should be agreed between medical nursing and laboratory staff for dealing with massive blood loss.

Blood Coagulation Disorders↗
PubMed1993

[The treatment of postoperative pain in obstetrical-gynecologic surgery. A comparative study between ST-679 and paracetamol].

In double-blind conditions, ST-679 (a single oral 1200 mg dose in 20 patients), or paracetamol (a single oral dose of 1000 mg in 20 patients) was administered to forty patients who presented pain as a result of obstetrical-gynecological surgery. The study proposed to evaluate the analgesic efficacy and tolerability of ST-679, a new non-steroid antiphlogistic drug, as compared to a reference drug amply utilized in clinical practice such as paracetamol. The average estimation of tolerability, with regard to paracetamol, was significantly in favor of ST-679.

Acetaminophen↗
PubMedDate not supplied

A review of laparoscopy for non-obstetric-related surgery during pregnancy.

PURPOSE: Similar to the general population, parturients (and their fetuses) could benefit from the reduced manipulation associated with laparoscopy. The purpose of this article is to review the current state of knowledge (both clinical and experimental) with respect to the fetal effects of maternal laparoscopy for non-obstetric-related surgery during pregnancy. METHODS: Human and experimental animal results are examined, and we present preliminary data from our own laboratory. CONCLUSIONS: Future experiments are proposed to further develop and refine standards of care for general surgeons and obstetricians who are presented with gravid females in abdominal distress.

Animals↗
PubMed1971

Obstetric anaesthesia services in the United Kingdom.

In a survey of obstetric anaesthetic services in the United Kingdom questionnaires were sent to 398 hospital maternity units and 347 general-practitioner maternity units, of which 344 and 272 respectively were returned. Many hospitals were unable to provide an anaesthetist for obstetric surgery only, and few consultant anaesthetist sessions were allocated to obstetric surgery, particularly in regional hospitals in England and Wales. Constant supervision of junior anaesthetic staff with under 12 months' experience was lacking in several hospitals. Endotracheal intubation is widely used throughout the United Kingdom. Though regional analgesic techniques are used by most anaesthetists it is impossible to provide a 24-hour regional analgesic service in all but a few hospitals.

Anesthesia, Conduction↗