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At least 1,621 records · Page 90Linked to original sources
PubMed1999

[Transvaginal ultrasonic evaluation of the thickness of the section of the uterine wall in previous cesarean sections].

BACKGROUND: The aim of this study is to evaluate accuracy of transvaginal sonographic examination of the lower uterine segment in pregnant women with previous cesarean section. METHODS: Sixty-one pregnant women between 37 and 40 weeks of gestation, with previous cesarean section underwent transvaginal ultrasonography. Wall thickness of the lower uterine segment, the length of cervix, dilation of the isthmus uteri were measured. On the basis of the surgical findings (in 53 patients) and outcome of the trial of labor (in 8 patients) a Score was assigned to the pregnant women: Score 1 to the women who had good healing or a trial of labor without complications; Score 2 to the women with a thin or discontinued scar and in case of threatened rupture of the uterus in the trial of labor. RESULTS: The mean thickness of the lower uterine segment is 3.82 mm +/- 0.99 mm. The Score 1 group shows a mean thickness of 4.2 mm +/- 2.5 mm, and the Score 2 group a mean thickness of 2.8 mm +/- 1.06 mm. The transvaginal sonographic examination provides a sensitivity and a specificity respectively of 100 and 75%, for a thickness cut-off of 3.5 mm, and a positive and negative predictive values of 60.7% and 100% respectively. CONCLUSIONS: The transvaginal sonographic evaluation of the lower uterine segment improves therefore the obstetrical decision-making regarding the trial of labor in women with previous cesarean section.

Adult↗
PubMed2001

[Acute complete uterine inversion--care report].

OBJECTIVES: Acute puerperal uterine inversion is a rare but very feared obstetrical complication. It determines an almost immediate shock and serious metrorrhagia. It is a introflexion of parietes uteri which takes place during the third stage of labor or during the first hours of puerperium. It can be distinguished in inversion of I, II or III degree according to the zone concerned by the introflexion: only the fundus of the uterus, all the corpus emerging in the vagina or the entirety of the uterus coming out from the vulvar orifice. RESULTS: This is report a case of inversion of the uterus during third stage of labor in multiparous aged 24 years admitted to Department of Gynecology & Obstetric in Hospital of Słupsk. The uterine III degree inversion was spontaneous during third stage of labor and was immediately diagnosed. Manual manipulation was attempted immediately to reverse the inversion but it was not successful. Because patient fell in cardiovascular shock she was resusciated and the inverted uterus repositioned using Huntington's method under general anaesthesia. After intra-abdominal repositioning of the uterus the placenta was removed manually and intramural injection of oxitocine was done to avoid immediate relapse. Whole obstetrical procedure was carried out within one-half hour after inversion. CONCLUSIONS: Although uncommon, in left unrecognized, uterine inversion will result in severe hemorrhage and shock, leading to maternal death. Manual manipulation should be attempted immediately to reverse the inversion. In the most resistant of inversions, surgical correction might be required. Following inversion of the uterus, further normal pregnancies can be expected.

Acute Disease↗
PubMed2001

[Overweight and obesity as the risk factor in perinatology].

Overweight and obesity have become a frequent phenomenon among pregnant women during last thirty years. They result in increased morbidity rates of different chronic, health- or even life-threatening diseases. Among different perinatal complications associated with obesity the most important are: hypertension, diabetes, varices, cholecystolithiasis, prolonged pregnancy, intrauterine growth retardation. Increased rates of operative deliveries, intrapartal and postpartal infections, thrombotic complications, anaemia, urinary infections and lactation disorders can be observed.

Adult↗
PubMed1990

Management of pregnancy after major urinary reconstruction.

Major reconstructions of the urinary tract are being performed with increasing frequency. However, published experience concerning pregnancy after urinary reconstruction is limited. Complications in women who have undergone such complex procedures may endanger them or their fetuses and can disrupt the reconstruction or impair renal function. To counsel better those patients who have undergone urinary reconstruction and who desire to bear children, and to develop an approach to the management of their pregnancies, we reviewed the available literature. We found that the incidence of complications was low during pregnancy after a genitourinary reconstruction; the majority of women had an uneventful pregnancy and vaginal delivery. Close observation of renal function and prophylaxis against urinary tract infection during pregnancy are recommended. Elective cesarean is advised for women who have had a reconstruction of the bladder neck or urethra or who have received an artificial urinary sphincter. Urologists and gynecologists must continue to report the outcome of pregnancy in their patients who have undergone reconstruction so that we may develop meaningful data about the incidence of complications.

Female↗
PubMed1978

[Mediolateral versus median episiotomy (author's transl)].

From 1969 to 1976, 15,715 episiotomies were done in 24,598 deliveries. The median episiotomy was progressively preferred and the technique of suture improved. The incidence of secondary sutures for dehiscence was reduced from 74 (3.4%) in 1971 to 6 (0.3%) in 1976. Extension into the rectum expectedly rose in incidence. The figures presented, show that the complication rate following mediolateral episiotomy is higher than following median episiotomy including the complication rate with extensions into the rectum.

Episiotomy↗
PubMed1995

[Familial occurrence and obstetric complications in siblings discordant for schizophrenia].

Obstetric complications seem to play a relevant role in the development of schizophrenia. This study aimed to assess whether not only frequency but also severity of obstetric complications was different in schizophrenic patients when compared with their healthy siblings. Furthermore, we examined whether a family history positive for schizophrenia was related to an increased frequency or severity of obstetric complications in healthy siblings. Frequency and severity of obstetric complications were evaluated in 76 subjects (30 schizophrenics and 46 siblings). The diagnosis of schizophrenia were made according to DSM III-R. Mothers were interviewed to gather data about obstetric complications and the "midwife protocol" by Parnas et al. (1982) was used to quantify presence and entity of obstetric complications. Information regarding family history were collected from mothers. We used the method of segregation analysis to test the mode of inheritance. Complicated births were more frequently found in schizophrenics independently from a family history positive for schizophrenia or schizophrenia related personality disorders and obstetric complications were more severe in schizophrenics with respect to siblings. Obstetric complications occurred more frequently among schizophrenics without genetic risk; the same result was not found in healthy sibs. Our findings show that obstetric complications would play a major role in patients especially if they show a negative family history for schizophrenia. Moreover, a family history positive for schizophrenia or schizophrenia related personality disorder seems not to augment the frequency or severity of obstetric complications in healthy sibs.

Adult↗
PubMed1993

An analysis of the prediction of cephalopelvic disproportion.

Since cephalopelvic disproportion inevitably leads to cesarean section it seems to be mandatory to identify patients with an absolute discrepancy between the size of the fetus and the birth canal in order to avoid unnecessary trials of labour. In a case control study, comparing a group of patients who delivered by cesarean section because of cephalopelvic disproportion with an age matched control group, routinely assessed pelvic measurements and measurements of the newborn were correlated to cephalopelvic disproportion. Multivariate linear regression was applied to each group to determine, which of the maternal and fetal factors had the strongest influence on the mode of delivery. In the study group external conjugate showed the strongest positive relation to maternal body height (P < 0.01), the biparietal diameter of the newborn was negatively correlated (P < 0.01). None of the analyzed variables reached statistical significance in the control group. Differences between the two groups were marginal, thus providing no safe basis for decision making even in a population at high risk for developing cephalopelvic disproportion.

Adult↗
PubMed1995

[Torsion of the pregnant uterus].

Pathological version of the pregnant uterus is a rare complication. A case of 180 degrees sinistrotorsion of the uterus in the 39th gestational week is reported. The case was asymptomatic with the exception of preterm labor in the 30th week of pregnancy and was discovered during a cesarean section carried out because of myoma obstructing the birth canal. Mother and child were discharged in perfect health.

Adult↗
PubMed1990

Prevalence of urinary incontinence among women at a Swedish primary health care centre.

Information on urinary incontinence was obtained by means of a questionnaire from women visiting a Swedish health centre. Among women aged 18 and above, 44% stated that they had urinary incontinence. About one-third of these women reported stress incontinence, one-third urge incontinence, and one-third both. Urinary incontinence was more prevalent with increasing age and was more common among women who had given birth to children, in overweight women, in women taking diuretics, and in women with some defined diseases. Of those with incontinence, 13% stated that it impaired their work and 28% that it impaired leisure activities. Many of them had not asked for medical help for the symptom. It is important to emphasize the high prevalence of the symptom, and even more important to increase our knowledge of how best to take care of these women.

Adult↗
PubMed1994

Vaginal birth after cesarean section: an update on physician trends and patient perceptions.

The increased number of women having a vaginal birth after a cesarean section can be attributed to changing physician trends. Women eligible for vaginal birth after cesarean section include those with previous low vertical incisions, multiple previous incisions and even unknown scars, regardless of the method of closure or previous indication. Limited data suggest that in carefully selected women a current twin gestation, breech presentation, or the presence of fetal macrosomia are not contraindications for a trial of labor, in the presence of a uterine scar. Changing trends in the management of labor may also contribute to an increase in successful trial of labor with the use of oxytocin for the induction or augmentation of labor, the administration of epidural anesthesia for pain relief, and the instillation of prostaglandin E2 gel for cervical ripening. External cephalic version and amnioinfusion may also be reasonable alternatives in appropriately selected cases. Despite the documented safety and success of vaginal birth after cesarean section, and the lack of increased morbidity of failed trial of labor, 50% of women who are eligible for vaginal birth after cesarean section will decline an attempt, even after extensive counseling and encouragement. Patient resistance, largely attributed to the fear and inconvenience of labor, is still a major deterrent to a further rise in vaginal birth after cesarean section rates.

Anesthesia, Epidural↗