Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Obstetrical Surgery”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 289 records · Page 16Linked to original sources
PubMed2003

Minimally invasive management of ureteral injuries recognized late after obstetric and gynaecologic surgery.

We evaluated whether iatrogenic ureteral injuries recognized late after obstetric and gynaecological surgery were likely to resolve with minimally invasive strategies. We reviewed our records of 30 patients with surgical ureteral injuries diagnosed after obstetric and gynaecological operations. From collected data, the outcome of minimally invasive strategies and operative repair was evaluated and compared. Thirteen patients were treated primarily by operative repair and 17 were treated by minimally invasive strategies including percutaneous nephrostomy drainage, ureteral stent placement, or both. All patients treated by operative repair obtained primary healing. Of 17 patients treated by minimally invasive strategies, 11 had recovery of injured ureters but additional procedures were needed in six. We conclude that minimally invasive strategies are not always successful in the management of ureteral injuries recognized late after obstetric and gynaecological surgery.

Adult↗
PubMed2005

Pregnancy outcome following non-obstetric surgical intervention.

OBJECTIVE: To evaluate the effects of non-obstetric surgical procedures on maternal and fetal outcome. METHODS: A systematic review of all English language literature. RESULTS: Fifty-four papers met the inclusion criteria. The overall number of patients reported was 12,452. Reported maternal death was rare at .006%. The miscarriage rate was 5.8%; however, this number is difficult to interpret since matched controls were not available. The rate of elective termination of pregnancy following non-obstetric surgery was 1.3%. The rate of premature labor induced by non-obstetric surgical intervention was 3.5% and this was noted specifically following appendectomy versus other types of interventions (P<.001). A total of 2.5% of pregnancies resulted in fetal loss. The prematurity rate was 8.2%. The rate of major birth defects among women who underwent non-obstetric surgical intervention in the first trimester was 3.9%. Sub-analysis of papers reporting on appendectomy during pregnancy revealed a high rate (4.6%) of surgery-induced labor. Fetal loss associated with appendectomy was 2.6%; however, this rate was increased when peritonitis was present (10.9%). CONCLUSIONS: Modern surgical and anesthesia techniques appear to diminish the rate of maternal death. Surgery in the first trimester does not appear to increase major birth defects and should not be delayed when indicated. Acute appendicitis with peritonitis is associated with higher risk to the mother and fetus.

Appendectomy↗
PubMed2002

The effect of outpatient preoperative evaluation of hospital inpatients on cancellation of surgery and length of hospital stay.

UNLABELLED: To evaluate the possible effects of outpatient preoperative evaluation (OPE) for new surgical patients who will be inpatients, we conducted an observational study at a university hospital in The Netherlands. Various outcomes before and after the introduction of an OPE clinic were compared. The study population comprised all 21,553 elective adult inpatients operated on between January 1, 1997 and December 31, 1999. Cardiac surgery, obstetric and pediatric patients, and patients operated on in same-day surgery were excluded. The main outcome measures were surgical cases canceled for medical reasons, rate of same-day admissions (who were expected to increase), and length of hospital stay. After introduction of OPE, the rate of cancellations for medical reasons decreased from 2.0% to 0.9% (adjusted odds ratio 0.7, 95% CI, 0.5--0.9). The rate of same-day admissions increased from 5.3% before to 7.7% after OPE introduction (adjusted odds ratio 1.2, 95% CI, 1.01--1.39), and the total hospital length of stay (in days) significantly decreased by a factor of 0.92 (0.90--0.94), which was partly the result of a reduction in preoperative admission time. We concluded that, although smaller than anticipated, the use of OPE for potential inpatients leads to a significant reduction of cancelled cases and of length of admission. Further increase of these benefits from OPE requires changes in institutional policy, such as forcing surgical departments to increase their number of same-day admissions. IMPLICATIONS: An observational study was conducted to compare various outcomes before and after the introduction of outpatient preoperative evaluation (OPE). Although smaller than anticipated, OPE for potential inpatients leads to a significant reduction of canceled cases and of length of admission.

Adult↗
PubMed2000

Women in hospital medicine in the United Kingdom: glass ceiling, preference, prejudice or cohort effect?

OBJECTIVE: To assess from official statistics whether there is evidence that the careers of women doctors in hospitals do not progress in the same way as those of men. DESIGN: The proportions of female hospital doctors overall (1963-96), and in the specialties of medicine, surgery, obstetrics and gynaecology, pathology, radiology/radiotherapy, anaesthetics and psychiatry (1974-1996) were examined. Additionally data were examined on career preferences and intentions from pre-registration house officers, final year medical students, and medical school applicants (1966-1991). ANALYSIS: Data were analysed according to cohort of entry to medical school to assess the extent of disproportionate promotion. RESULTS: The proportion of women in hospital career posts was largely explained by the rapidly increasing proportion of women entering medical school during the past three decades. In general there was little evidence for disproportionate promotion of women in hospital careers, although in surgery, hospital medicine and obstetrics and gynaecology, fewer women seemed to progress beyond the SHO grade, and in anaesthetics there were deficits of women at each career stage. Analyses of career preferences and intentions suggest that disproportionate promotion cannot readily be explained as differential choice by women. CONCLUSIONS: Although there is no evidence as such of a "glass ceiling" for women doctors in hospital careers, and the current paucity of women consultants primarily reflects historical trends in the numbers of women entering medical school, there is evidence in some cases of disproportionate promotion that is best interpreted as direct or indirect discrimination.

Adult↗
PubMed1998

Single- versus multiple-dose antimicrobial prophylaxis for major surgery: a systematic review.

BACKGROUND: Single-dose antimicrobial prophylaxis for major surgery is a widely accepted principle; recommendations have been based on laboratory studies and numerous clinical trials published in the last 25 years. In practice, single-dose prophylaxis has not been universally accepted and multiple-dose regimens are still used in some centres. Moreover, the principle has recently been challenged by the results of an Australian study of vascular surgery. The aim of this current systematic review is to determine the overall efficacy of single versus multiple-dose antimicrobial prophylaxis for major surgery and across surgical disciplines. METHODS: Relevant studies were identified in the medical literature using the MEDLINE database and other search strategies. Trials included in the review were prospective and randomized, had the same antimicrobial in each treatment arm and were published in English. Rates of postoperative surgical site infections (SSI) were extracted, 2 x 2 tables prepared and odds ratios (OR) [with 95% confidence intervals (95% CI)] calculated. Data were then combined using fixed and random effects models to provide an overall figure. In this context, a high value for the combined OR, with 95% CI > 1.0, indicates superiority of multiple-dose regimens and a low OR, with 95% CI < 1.0, suggests the opposite. A combined OR close to 1.0, with narrow 95% CI straddling 1.0, indicates no clear advantage of one regimen over another. Further subgroup analyses were also performed. RESULTS: Combined OR by both fixed (1.06, 95% CI, 0.89-1.25) and random effects (1.04, 95% CI, 0.86-1.25) models indicated no clear advantage of either single or multiple-dose regimens in preventing SSI. Likewise, subgroup analysis showed no statistically significant differences associated with type of antimicrobial used (beta-lactam vs other), blinded wound assessment, length of the multiple-dose arm (> 24 h vs 24 h or less) or type of surgery (obstetric and gynaecological vs other). CONCLUSIONS: Continued use of single-dose antimicrobial prophylaxis for major surgery is recommended. Further studies are required, especially in previously neglected surgical disciplines.

Anti-Bacterial Agents↗
PubMedDate not supplied

Epidural anesthesia for obstetrics after spinal surgery.

The experience of 18 patients with previous spinal surgery who requested epidural anesthesia for obstetric pain was reviewed. Three received epidural anesthetics in two separate pregnancies, producing a total of 21 attempts at epidural anesthesia. All were initiated during labor and three were later extended for Cesarean delivery. Continuous lumbar epidural anesthesia was successfully established in 20 of 21 attempts. Ten were performed easily on the first attempt. There were excessive local anesthetic requirements and/or a patchy block for the remaining 11 attempts. The only complication that could be attributed to the attempts at epidural anesthesia was temporary low back pain in two patients with multiple attempts. No complications were noted on long-term follow-up. Our data, therefore, suggest that epidural anesthesia is safe and generally effective in obstetric patients with previous spinal surgery.

Analgesia, Epidural↗
PubMed1992

[Forensic problems in bovine obstetrics and gynecology].

In the published statistical reports of liability insurance companies for veterinarians a high percentage of damage claims falls into the field of obstetrics and gynaecology, particularly in the bovine species. Veterinarians are held responsible for the consequences of insufficient clinical examinations of female animals or, after a correct diagnosis, initiation of therapeutic measures that ar not indicated. An increasing number of damage claims is due to the fact that the veterinarian has not informed the owner of an animal in advance about the possible medical or economic risks of a particular treatment. From the expert opinions requested of our clinic by insurance companies and law courts, it can be concluded that in veterinary obstetrics, lesions and damages occurring during vaginal deliveries are still the most frequent cause of compensation claims. Veterinarians are blamed for the use of too much traction force (number of persons assisting in an extraction, use of mechanical calf-pullers) and for incorrect procedures during the manual or instrumental correction of postural or positional abnormalities or a uterine torsion. Also, in case of complications after obstetrical surgery owners suspect failure of the veterinarian. Many losses in the puerperal period are due to the fact that the clinical examination after an obstetrical intervention has not been performed with the necessary accuracy or has been completely omitted. Compensation claims after gynaecological procedures are mostly based on a falsely positive or negative pregnancy diagnosis and complications after surgery involving the ovaries.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2006

Iatrogenic ureteric and bladder injuries in obstetric and gynaecologic surgeries.

OBJECTIVE: To review iatrogenic ureteric and urinary bladder injuries from obstetric and gynaecological surgeries treated in the urology department analysing; ureteric anatomy, aetiologic factors, diagnosis, treatment and outcomes. DESIGN: A retrospective study. SETTING: Institute of Urology, Kilimanjaro Christian Medical Center (KCMC), Moshi, Tanzania. SUBJECTS: Twenty three women were treated for iatrogenic ureteric and bladder injuries secondary to obstetric and gynaecological procedures in the department of urology between June 1994 and July 2004. RESULTS: Hysterectomy was the leading cause of ureteric injuries contributing to nine (47.4%) of the 19 ureteric injuries. Caesarian sections were the second leading cause and contributed 6(31.6%) of 19 ureteric injuries. Vesical vaginal fistula (VVF) repairs lead to two (10.5%) ureteric injuries one of which was bilateral. There was a case each (5.3%) from ovarian cystectomy and forceps delivery. There were only three cases of intra-operative diagnosis of ureteric injuries. There were four bladder injuries half of which came from hysterectomy. The leading definitive urological treatment for ureteric injury was ureteric re implantation and all kidneys were saved. CONCLUSION: Iatrogenic ureteric and bladder injuries from gynaecologic surgeries are globally rare but are liable to occur due to the inherent ureteric anatomic factors in the pelvis. Intra-operative diagnosis of injury is a rare feature. The practical principles to prevent and repair ureteric injuries have been presented and discussed. The true risk to the patient lies in delayed, missed diagnosis and inadequate treatment. Endourologic techniques offer an alternative diagnostic and treatment method for women previously injured in open pelvic surgeries.

Adult↗
PubMed1983

[Ranitidine for premedication in obstetric anesthesia. Possibilities and limitations for prevention of Mendelson syndrome].

45 healthy young women received 50 mg Ranitidin as soon as the anaesthetist was informed that general anaesthesia was necessary for an obstetric manoeuvre. During the procedure the gastric contents were analysed quantitatively and the pH values were measured. In the parturient women, the Ranitidin effect was not attained within thirty minutes, contrary to the results obtained in male volunteers. Neutralisation was not obtained in male volunteers. Neutralisation was not obtained in all of the patients even within sixty minutes. Hence, intravenous Ranitidin cannot prevent acid aspiration in non-elective obstetric surgery if employed as the only precaution.

Adolescent↗
PubMed1980

Antimicrobial prophylaxis in obstetric and gynecologic surgery: a critical review.

Thirty-three human studies concerned with antimicrobial prophylaxis in obstetric-gynecologic surgery were analyzed, with particular attention to experimental design. Eighty-two percent of the studies were prospective, 70% randomized and 39% double-blind. Patients were stratified according to underlying disease in 15%, complications of prophylaxis were mentioned in 61% of the studies, and statistical analysis was done in 55% of the studies. There was considerable variation in antibiotics employed and in the types of infection encountered. Twenty-seven of the 28 papers published after 1966 advocated prophylaxis. In contrast, less than two thirds of the papers concerned with general surgery support the use of perioperative prophylactic antibiotics. Despite some variability in methodology and antibiotic agents used, there is little controversy among the studies analyzed.

Anti-Bacterial Agents↗
PubMed2003

[Prevention of hypotension in spinal anaesthesia carried out for caesarean section].

After describing the most commonly applied obstetric indications for caesarean section and the respective percentages reported in countries that are comparable with Italy in terms of health care standards, the clinical reasons and requirements on the basis of which it is considered that spinal anaesthesia is first choice compared to general anaesthesia in obstetrical surgery are outlined. This evidence is confirmed by the spinal anaesthesia/general anaesthesia ratio encountered in the major national and international Obstetric Hospitals. Maternal hypotension remains the most frequent and clinically important complication consequent on spinal anaesthesia in pregnant women at term. The aetiology, frequency and clinical consequences for mother and foetus of severe maternal hypotension and the need to implement effective preventive therapeutic strategies are therefore discussed. The procedures for preventing maternal hypotension are described and for each procedure its validity and standardisation are assessed. It is pointed out that certain procedures have become part of standard practice but their effectiveness has not yet been confirmed while others are not only ineffective but also expose mother and foetus to potential complications. For others again the jury is still out on their real effectiveness. Finally, the techniques that are currently considered to be effective and shared by the majority of authors are described and these must therefore be included in the procedural protocols regarding spinal anaesthesia for caesarean section.

Adult↗
PubMed2005

Perioperative assessment of the obstetric patient undergoing abdominal surgery.

Care of the obstetric patient undergoing nonobstetric surgery can be challenging. Approximately 1 in 500 pregnancies is complicated by a nonobstetric surgical condition. To adequately care for the mother and fetus, the nurse must know the physiological changes that occur during pregnancy, and make an aggressive attempt to maintain those changes. This article reviews common reasons for abdominal surgery during pregnancy, the physiological changes that occur during pregnancy, techniques to maintain those responses, and discusses issues related to fetal monitoring and postoperative care.

Cesarean Section↗
PubMed2005

Exploratory factor analyses of the CAHPS Hospital Pilot Survey responses across and within medical, surgical, and obstetric services.

OBJECTIVES: To estimate the associations among hospital-level scores from the Consumer Assessments of Healthcare Providers and Systems (CAHPS) Hospital pilot survey within and across different services (surgery, obstetrics, medical), and to evaluate differences between hospital- and patient-level analyses. DATA SOURCE: CAHPS Hospital pilot survey data provided by the Centers for Medicare and Medicaid Services. STUDY DESIGN: Responses to 33 questionnaire items were analyzed using patient- and hospital-level exploratory factor analytic (EFA) methods to identify both a patient-level and hospital-level composite structures for the CAHPS Hospital survey. The latter EFA was corrected for patient-level sampling variability using a hierarchical model. We compared results of these analyses with each other and to separate EFAs conducted at the service level. To quantify the similarity of assessments across services, we compared correlations of different composites within the same service with those of the same composite across different services. DATA COLLECTION: Cross-sectional data were collected during the summer of 2003 via mail and telephone from 19,720 patients discharged from November 2002 through January 2003 from 132 hospitals in three states. PRINCIPAL FINDINGS: Six factors provided the best description of inter-item covariation at the patient level. Analyses that assessed variability across both services and hospitals suggested that three dimensions provide a parsimonious summary of inter-item covariation at the hospital level. Hospital-level factor structures also differed across services; as much variation in quality reports was explained by service as by composite. CONCLUSIONS: Variability of CAHPS scores across hospitals can be reported parsimoniously using a limited number of composites. There is at least as much distinct information in composite scores from different services as in different composite scores within each service. Because items cluster slightly differently in the different services, service-specific composites may be more informative when comparing patients in a given service across hospitals. When studying individual-level variability, a more differentiated structure is probably more appropriate.

Attitude of Health Personnel↗
PubMed2001

[Urologic complications of gynecologic surgery. Report of 16 cases].

From 16 cases collected in eight years (January 1991-December 1999) in the I. Deen Teaching Hospital Department of Urology, the authors study the gynaecological and obstetric surgery urological complications. They noted that these complications interest in 80% of cases the 18-47 years old woman with a high parity in 70% of cases. Hysterectomy, whatever the indication is the main etiology: 62.50%, caeserean takes the second place with 25%. The anatomic lesions are ureteral in 68.75% of cases and bladder in 31.25%. In the 14 cases treated, in the department, uretero reimplantation has been done in 46.66%, bladder suture in 40% and nephrectomy in 6.66%. Thirteen women were healed and one died.

Adolescent↗
PubMed2003

The combined spinal--epidural technique.

In recent years, the use of regional anaesthesia techniques for surgery, obstetrics and post operative pain management have increased in popularity. The combined spinal-epidural (CSE) technique has attained widespread popularity for patients undergoing major surgery below the umbilicus who may require prolonged and effective postoperative analgesia. The CSE technique is now well established in several institutions. This chapter includes the clinical experience, advantages and potential problems, and discusses future perspectives of the CSE technique.

Ambulatory Surgical Procedures↗
PubMed1998

Anti-aspiration prophylaxis in New Zealand: a national survey.

A postal questionnaire was sent on two occasions to specialist anaesthetists within New Zealand. Questions were related to fasting status, anti-aspiration prophylaxis, incidence of aspiration, definition of high risk groups for aspiration pneumonitis, and identification of departmental guidelines. Two-hundred-and-twenty-three replies were received (72% response rate). Most adults, children and infants were fasted for 6 hours for solids, whilst the majority fasted for 2 to 4 hours for liquids. Two-thirds indicated that they would delay emergency surgery (not life/limb threatening) to optimize gastric emptying. Histamine type 2 receptor antagonists, metoclopramide and cricoid pressure were used commonly, more so in the obstetric population compared to non-obstetric surgery. Preinduction nasogastric intubation and suction were used infrequently. Anti-aspiration prophylaxis was deemed important in morbidly obese patients, those in the third trimester of pregnancy and those with a hiatus hernia, whilst diabetes mellitus, sepsis and renal failure were not considered risk factors for aspiration pneumonitis. 71% of respondents had at least one episode of aspiration (range 0-10), with an overall mortality rate of 5%. Half of these cases of aspiration were deemed to be preventable by the respondent.

Adolescent↗
PubMed1972

A family practice survey in Ventura County.

Seventy-five percent of family practitioners in Ventura County, California, responded to a seven-page mailed questionnaire. One third of the practitioners do no obstetrics. The physicians counsel seven patients to every delivery performed and to every surgical procedure performed. Family practice consists of medicine and pediatrics, rather than surgery, obstetrics and psychiatry. Family practitioners use referrals to community health care services in a limited fashion. Lack of information about availability of community resources may be the reason.

California↗
PubMed2001

Use of remifentanil in a patient with peripartum cardiomyopathy requiring Caesarean section.

We describe a case of a 26 yr old primigravida at 39 weeks' gestation, with a diagnosis of peripartum cardiomyopathy, requiring urgent Caesarean section. The patient presented in severe heart failure and active labour. A general anaesthetic, using a target-controlled infusion of propofol and an intravenous infusion of remifentanil, was used to provide stable anaesthesia and analgesia for a successful delivery. The unusual diagnosis of peripartum cardiomyopathy and the potential benefits of the use of remifentanil in high-risk obstetric surgery are discussed.

Adult↗