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PubMed2005

Cervical length at 23 weeks' gestation--relation to demographic characteristics and previous obstetric history in South African women.

OBJECTIVES: To determine the distribution of cervical length in a routine population of singleton pregnancies; to examine the relationship between cervical length, demographic characteristics, and previous obstetric history; and to compare these data with data from a similar study undertaken in the UK. PATIENTS AND METHODS: The study was conducted among women attending routine antenatal clinics at Coronation, Johannesburg General and Chris Hani Baragwanath hospitals. Cervical length was measured by means of transvaginal ultrasound at 23 weeks' gestation in women with singleton pregnancies attending these clinics, as part of a multicentre randomised trial investigating the value of cerclage in a short cervix. The distribution of cervical length was determined and the significance of differences in median cervical lengths between subgroups was calculated according to maternal age, ethnic origin, maternal body mass index (BMI), cigarette smoking, alcohol intake, and previous obstetric history. RESULTS: Cervical screening was offered to women (N = 2 173) attending clinics for a 23-week scan during the study period (July 1999-September 2002). Most women (N = 1 920) accepted, while 253 declined. Complete outcomes (date and mode of delivery, gestation at delivery, birth weight, Apgar scores, maternal blood loss, whether the patient was cerclaged or not, and any complications) were obtained for 1 603 women who accepted screening. Cervical length was measured successfully in all cases. Median cervical length was 33.7 mm and in 64 cases (3.3%) the length was 15 mm or less. Significantly shorter cervical lengths were found in those with a history of previous miscarriage, preterm delivery, those aged less than 20 years and those with an abnormal BMI. Cervical length was not significantly shorter in black women than in coloured and white women. CONCLUSIONS: At 23 weeks' gestation the median cervical length in a South African population was 33.2 mm. In 3.3% of the population the length was < or = 15 mm. There was an association between cervical length, demographic characteristics and previous obstetric history.

Adult↗
PubMed2006

[Study of the injury to the urinary system caused by radiological vascular interventional therapy of obstetrical and gynecological benign diseases].

OBJECTIVE: To explore the injuries to the urinary system caused by uterine artery embolization (UAE) for treatment of obstetrical and gynecological benign diseases, including the classification, aetiology, therapy of the injuries and precaution methods. METHODS: The injuries of the urinary system were reviewed in 960 cases of obstetrical and gynecological benign diseases treated with UAE by our interventional centre. Of all 960 cases, 690 cases were myoma, 244 adenomyosis, 8 cervical pregnancy, 2 cornus pregnancy, 14 postpartum hemorrhage, 2 late postpartum hemorrhage. Meanwhile, the correlative problems of the vascular anatomy, DSA and the embolization technics of microcatheter were analyzed. RESULTS: (1) Different degrees of urinary system injuries occurred in 5 of 960 cases, the rate was 0.5%. None was severe injury, one case (0.1%) was moderate injury, and the patient suffered of hydronephrosis caused by segmental necrosis of unilateral ureter. Mild injury occurred in 4 cases (0.4%), including one case of inflammation of bladder, one case of partial necrosis of bladder mucosa membrane, 2 cases of transient slight unilateral hydronephrosis. Among all the injuries, 4 occurred in myoma patients, and one occurred in adenomyosis patient. The operation procedures of all five cases were bilateral uterine artery embolization, and none used microcatheter. (2) The ureter branch arising from the middle or lower part of the uterine artery supplied the middle or lower part of ureter and the length of this part of ureter is about 4 cm, the bladder branch arising from the middle or lower part of uterine artery supplied the bladder and communicated with the bladder vascular net. Correlative injuries could be caused by the retroflow of embolisms into the above arteries. (3) Placement of the catheter into the upper branch of the uterine artery or the tumor vascular net, using microcatheter if necessary and notation of the retroflow in the embolization process could avoid the embolization of bladder and ureter arteries. (4) Totally 506 cases used microcatheter, the ratio was 52.7%. The 5 cases of injuries did not use microcatheter. CONCLUSIONS: Injuries to the urinary system could occur in UAE for treatment of obstetrical and gynecological benign diseases, which can be prevented by carefully differentiating the vascular communicating branch and the conditions of branches, and embolization of the upper branch of uterine artery can avoid the injury.

Angiography, Digital Subtraction↗
PubMed2006

[Syndrome of acute abdomen in gynaecology and obstetrics].

The syndrome of acute abdomen in gynecology and obstetrics can develop due to inflammatory, ischemic-obstructive and hemorrhagic intra-abdominal etiology as a complication of primary disease, pathologic processes on some organs or injuries (genital, gastrointestinal, urinary, vascular, neurologic and musculoskeletal systems). Clinical and ultrasound examination, x-ray diagnosis, laparoscopy (in early pregnancy) and laboratory findings are the basic diagnostic methods to evaluate etiology of acute abdomen syndrome in gynecology and obstetrics. Rare cases with atypical clinical pictures and etiology of acute abdomen syndrome in gynecologic and obstetric casuistic are described.

Abdomen, Acute↗
PubMed2006

[Epidemiology of congenital malformations in neonates born alive in the Institute of Gynecology and Obstetrics of Medical University in Lodz in the years 2001-2003].

UNLABELLED: Institute of Gynaecology and Obstetrics of Medical University in Lodz acceded the Polish Register of Congenital Malformations and keeps on propagating the program. The aim of the study was to estimate the frequency of congenital malformations in newborns delivered in the Institute of Gyneacology and Obstetrics in Lodz in the years 2001-2003 and to analyse some epidemiological parameters concerning inborn defects in the region of Lodz. The study is based on the retrospective analysis. All neonates born alive in our Institute in the years 2001-2003 were taking into consideration. The data about inborn malformations was collected from the medical documentation and the results were confronted with demographic analysis of the region of Lodz. RESULTS: Among 66474 neonates born alive during analysed period of time in the region of Lodz, 4507 (6,78%) were delivered in the Institute of Gyneacology and Obstetrics in Lodz. There were 106 newborns congenitally malformed, so the percentage of inborn defects reached 2,35% of all neonatal population. From the region of Lodz 966 babies with inborn malformations were notified to the Polish Register of Congenital Malformations, and 106 (10,9%) malformed newborns were registered from our Institute. Malformations of heart and circulatory system were the most frequent--28,8%, defects of skeletal and muscular system were the next -18%, and malformations of urogenital system formed 16,2%. In the region of Lodz there were 477 neonatal deaths and 121 cases were caused by congenital anomalies, which makes the percentage of 25,4% of neonatal mortality. CONCLUSION: 1. Congenital malformations are the one of the main reasons of neonatal and infantile mortality. 2. The program of registrating malformations helps in exact epidemiological analysis of congenital anomalies in newborns.

Abnormalities, Multiple↗
PubMed1991

Autologous blood use in obstetrics.

The use of autologous blood is of growing concern in the practice of obstetrics. Although prior donation of one's blood for later surgical use and the emergency use of reinfused blood have become established practices, obstetrical use remains controversial because only small groups of women have been studied. This paper gives a brief overview of current issues and use of autologous blood donation in pregnancy and in intraoperative obstetrical procedures.

Blood Transfusion, Autologous↗
PubMed1990

[Predicting obstetrical complications in the pubertal period].

A protocol has been obtained for an individualized prediction of obstetric complications already in pubertal years. A predictive rating chart and a scale were compiled to determine the risk of gestational anemia and intrapartum bleedings. This approach was tested using a retrospective analysis of pubertal progress in 75 primigravidae in an antenatal clinic of Karaganda. Individualized prediction of obstetric complication is recommended for implementation in obstetric facilities.

Adolescent↗
PubMedDate not supplied

[Indications and results of autotransfusion. Normovolemic hemodilution in gynecology-obstetrics].

Considering the importance of haemorrhagic complications in gynaecology-obstetrics and the increasing fear of accidents during blood transfusion, the authors propose, from the literature and the study of 13 cases, a reflection on the indications of deferred autotransfusion (DAT) and of normovolemic haemodilution (NVH). In obstetrics, even if DAT has undoubtedly certain advantages (besides viral contaminations, appearance of allo-antibodies...), it can be indicated at present only for pregnant women exposed to a predictable risk of haemorrhage or for women with a rare blood group. In gynaecology, the authors have not found any significant advantages in our study as regards NVH associated with DAT. However, as in obstetrics, the technique is harmless, and no thrombo-embolic complications have been observed, even in women at high thrombotic risk. These methods are expensive and require qualified personnel. Their exact modalities and indications, as well as their medico-legal aspects, are yet to be defined.

Adult↗
PubMed1989

Survival and morbidity of extremely premature infants based on obstetric assessment of gestational age.

To provide current clinical information for obstetric decision-making and perinatal management, we present early morbidity and mortality data for extremely premature infants based on obstetric assessment of gestational age. We reviewed the records of 141 live-born infants with birth weights of 1600 g or lower born at a university hospital level III neonatal intensive care unit between January 1986 and April 1988, whose gestational ages estimated by antenatal obstetric evaluation were between 24-29 completed weeks. Neonatal survival to 30 days ranged from 20% at 24 weeks to 94% at 29 weeks. Chronic lung disease was present at 30 days in all infants born at 24 weeks' gestation, decreasing to 13% of infants born at 29 weeks' gestation. Rates of severe intraventricular hemorrhage (grade 3 or 4) ranged from 100% at 24 weeks to 7% at 29 weeks. These data represent a significant increase in survival and a decrease in early morbidity compared with those form similar populations before 1986.

Birth Weight↗
PubMed1989

[Causes of the occurrence of urogenital fistulae in obstetrics and gynecology].

Ninety-two women with urogenital fistulas of obstetric-gynecological origin have been treated at the Department of Urology of the Medical Academy in Sofia for the period Jan. 1974-July 1988. The causes of the fistulas in 17 patients (18.5 per cent) were of obstetric origin and in 75 (81.5 per cent) of gynecological origin. Analysis of the causes revealed that the incidence of obstetric fistulas was higher than in other developed countries. Higher was also the incidence of radiogenic urogenital fistulas. Gynecological fistulas following operations of benign genital diseases were more common than those developing after total hysterectomies and Wertheim's operations for malignant tumors of the internal genitals. This is in contradiction to reports by other authors. It is suggested that urologist be included in the surgeons' staff in risk hysterectomies (in cervical myomatosis).

Adult↗
PubMedDate not supplied

Obstetrical ultrasound in remote communities: an approach to health program evaluation.

This paper illustrates one approach to evaluating the impact of an obstetrical ultrasound outreach program in remote Indian communities. The pregnancy characteristics and obstetrical outcomes of 240 deliveries in 2 groups of communities with and without the program are compared. After controlling for maternal age, parity, obstetrical risk score and presence of diabetes and hypertension during pregnancy, Program Area women are found to differ significantly from Control Area women in several medical care measures. There are more health care contacts, fewer medical referrals out of the community and a lower proportion of non-hospital births. There are however more inductions of labour and longer hospital stays. The small sample size was not sufficient to detect differences in rare events such as perinatal deaths. Despite its shortcomings, the quasi-experimental design provides health planners with important information regarding medical technologies and interventions, particularly when randomized controlled trials are deemed not to be feasible and the only alternative is unsubstantiated opinions.

Adult↗
PubMed1989

[Hysterectomy in obstetrics. Analysis and comparison of a group of cases from the Italian and the international literature (536 cases)].

The Authors made a comparison between the frequency of obstetric hysterectomies carried out at the "La Sapienza" University Obstetrics and Gynaecology Departments and of those reported in international publications regarding Great Britain, USA, Australia, Saudi Arabia and Libya. Data obtained covered the 462 hysterectomies effected out of the 442,174 births from 1972 to 1895. Results were compared as under: general frequency per number of births, reasons for surgery, type of operation carried out, age of the patient, gestation period, obstetrical history and complications.

Adolescent↗
PubMed1988

[Obstetrical hemostatic ligation of the uterine arteries and hypogastric arteries].

The author studies haemostatic vascular ligations in obstetrics, in order to codify the indication of BLUA and BLHA in obstetrical haemorrhages uncontrollable with classic therapeutic means. He comes to the following conclusions: in severe post-partum haemorrhages defined by a hypotonic uterus and resistant to classic therapy, BLUA is a simple, fast, harmless procedure when carried out on the ascending branches and providing a favorable result; in severe post-partum haemorrhages originating in the segmento-cervical area, one may resort: either to BLHA; or the BLUA, at their origin (but information is not yet available concerning clinical experiment). In severe haemorrhages originated in the parauterine areas, or the hypogastric arterial system, only BLHA may be effective; in severe obstetrical haemorrhages caused by coagulation disorders and untractable with classic methods, BLHA may be useful and prevent a haemostatic hysterectomy or a least decreases bleeding intra- or even post-operatively.

Arteries↗
PubMed1988

Recurrent herpes simplex virus labialis and the use of epidural morphine in obstetric patients.

A retrospective study of sequential obstetric patients delivering at University Hospital and receiving epidural anesthesia was conducted to determine if a suggested association exists between the recurrence of oral herpes simplex lesions and the use of epidural morphine. In a retrospective study of 291 patients, 13 of 134 (9.7%) receiving epidural morphine developed recurrent oral herpes lesions in contrast to 1 of 157 (0.6%) not receiving the drug (P less than 0.001). In a prospective hospital-based study of 729 consecutive obstetric patients, 146 patients received epidural opioids (morphine, fentanyl, or both) and 583 did not. Recurrent HSVL lesions occurred in 13 of 140 (9.3%) patients given epidural morphine but in only 6 of 583 (1.0%) not given epidural opioids (P less than 0.001). Three of the 13 patients with HSVL received both epidural morphine and fentanyl and 10 received only epidural morphine. Because of the small numbers of patients receiving only fentanyl, no relation between HSVL reactivation and epidural fentanyl could be established. In patients having caesarean sections, the association of recurrent HSVL and the use of epidural morphine was significant (P = 0.04), suggesting cesarean delivery was not a confounder. A hitherto undescribed triggering agent, epidural morphine, appears to be associated with reactivation of HSVL in obstetric patients in the postpartum period.

Adult↗
PubMed1986

[Fundamental and clinical studies on imipenem/cilastatin sodium in the field of obstetrics and gynecology].

A combination of imipenem (MK-0787), a new carbapenem antibiotic, plus cilastatin sodium (MK-0791), a dehydropeptidase inhibitor (MK-0787/MK-0791 = 1:1) was studied in the field of obstetrics and gynecology and the following results were obtained. Absorption and penetration into genital organ tissues were good. Following a 0.5 g/0.5 g intravenous drip infusion, the maximum plasma concentration in uterine arterial blood was 20.8 micrograms/ml, and the maximum concentrations of the drug in tissues were 9.9 approximately 16.8 micrograms/g, and these levels of MK-0787 exceeded the MIC values against main causative organisms. Rates of elimination of the drug from the tissue and from the plasma were similar. Against gynecological and obstetrical infections, a dose of 0.5 g/0.5 g twice daily for an average duration of 6.3 days produced a clinical efficacy ratio of 94.4% (17/18) and a bacteriological effects rating of 76.9% (10/13). As side effects, one patient showed an eruption and another had an elevated GOT and GPT. Based on the above results, MK-0787/MK-0791 appears to be effective against gynecological and obstetrical infections.

Adult↗
PubMed1986

[Fundamental and clinical studies of imipenem and imipenem/cilastatin sodium in the field of obstetrics and gynecology].

Fundamental and clinical studies of imipenem (MK-0787), a new type of carbapenem antibiotic, and MK-0787 combined with cilastatin sodium (MK-0791), a renal dipeptidase inhibitor, were carried out. The results obtained were as follows: MK-0787 500 mg alone or MK-0787 500 mg with MK-0791 500 mg was administered by intravenous drip infusion over 30 minutes. Plasma levels of the drug were similar either following the administration of 500 mg of MK-0787 alone or 500 mg of MK-0787 with 500 mg of MK-0791. When MK-0787 was administered with MK-0791, MK-0787 and MK-0791 levels at 2 hours after the end of infusion in uterine arterial plasma were 6.8 micrograms/ml and 3.2 micrograms/ml, respectively, and in venous plasma were 8.4 micrograms/ml and 4.7 micrograms/ml, respectively. MK-0787 tissue levels ranged from 0.8 microgram/g to 3.8 micrograms/g at 205 minutes after the end of infusion. Based on these results, the plasma and tissue levels of MK-0787 and MK-0791 with b.i.d. dosage exceeded the MICs of the drug against clinical isolates in the field of obstetrics and gynecology such as E. faecalis, E. coli Klebsiella sp., Peptococcus sp., Peptostreptococcus sp. and B. fragilis immediately after the administration. However, it seemed that the b.i.d. dosage was insufficient to maintain the in vivo concentration of these agents high enough to inhibit the growth of the above bacteria. Eighteen patients with obstetric and gynecologic infection (12 with intrauterine infections, 2 with pelvic dead space inflammation, 2 with pelvic peritonitis, 1 with a vaginal cuff abscess and 1 with a vulvar abscess) and 1 patient with other infection (abdominal wall abscess) were evaluated, but 1 patient with pelvic peritonitis was later excluded from the efficacy evaluation because of a serious illness. MK-0787/MK-0791 was administered twice daily in a 30-minute intravenous drip infusion. Clinical results were excellent in 1 patient, good in 16 and poor in 1, for an efficacy ratio of 94.4%. No side effects were observed. Only abnormal laboratory findings observed were elevation of S-GOT and S-GPT in 1 patient which normalized 2 weeks after the treatment was discontinued. These results suggest that MK-0787/MK-0791 will be useful for the treatment of obstetric and gynecologic infections.

Adult↗
PubMed1987

[Pharmacokinetic and clinical studies of cefuzonam in obstetric and gynecologic infections].

Cefuzonam (CZON, L-105), a new semisynthetic cephem antibiotic, was studied in the field of obstetrics and gynecology, pharmacokinetically and clinically. Following is a summary of the results. 1. Concentrations of CZON in serum and genital organs following intravenous drip infusion of 1 g of the drug over 60 minutes were measured. Samples were taken during 40 to 190 minutes after the end of the infusion. Ratios of concentrations of the drug transferred into genital organs to the concentration in the cubital venous serum were 0.5 to 1.5 in many cases. Levels of the drug in the genital organs examined well exceeded MICs for common causative organisms in obstetric and gynecologic infections. 2. Therapeutic effects of 1 g or 2 g of CZON by drip infusion twice daily were evaluated in 8 patients. Overall clinical efficacy was 62.5% (5/8). No side effects or abnormal laboratory findings due to the drug were noted. The results suggest that CZON is a useful antibiotic for obstetric and gynecologic infections.

Adolescent↗
PubMed1987

[Clinical studies on cefuzonam in obstetrics and gynecological infections].

To evaluate the usefulness and the safety of cefuzonam (CZON, L-105) against obstetric and gynecological infections, we conducted clinical trials and obtained the results summarized as follows. 1. Thirteen patients with obstetric and gynecological infections (intrauterine infection 2 cases, adnexitis 7, 1 case each of abscess of adnexa uteri, abscess of the vaginal wall, pyelonephritis, and mammitis) were treated with CZON. The CZON was administered by intravenous injection or intravenous drip infusion, 1 g twice daily for 4 to 7 days (8 g to 14 g in total). The clinical effect was good in 12 and poor in 1. 2. Four cases, on which other antimicrobial agents were ineffective, responded well to CZON. 3. The CZON displayed excellent effects on anaerobic bacteria (Peptostreptococcus anaerobius, Bacteroides fragilis) and Gram negative rods (Escherichia coli, Klebsiella pneumoniae). 4. No side effects or laboratory abnormalities were observed. 5. From the above results, CZON appeared to be an effective and useful drug for obstetric and gynecological infections.

Adult↗
PubMed1985

The efficacy of internal iliac artery ligation in obstetric hemorrhage.

During 1966 to 1982, 18 patients with severe obstetric hemorrhage underwent hypogastric artery ligation at our institution. Eight of 14 patients or 57 per cent (excluding three pregnancies which were terminated and a planned cesarean hysterectomy) had failed hypogastric artery ligations necessitating hysterectomy. Placenta accreta accounted for six patients of whom three required a hysterectomy. Uterine laceration was the second largest cause of hemorrhage in five patients, all of whom required a hysterectomy after hypogastric artery ligation failed. Hypogastric artery ligation does have a specific role in the management of obstetric hemorrhage, but it is not without substantial risk of failure. The obstetrician should carefully weigh whether or not the patient can undergo a more conservative procedure at the expense of a delay in the definitive treatment of hemorrhage. The instances presented herein should aid the clinician in deciding what is appropriate management for acute obstetric hemorrhage.

Acute Disease↗