Anaphylactoid syndrome of pregnancy. A devastating complication requiring intensive care.
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Adult↗
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Results for “LABOR COMPLICATIONS”
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Ultrasonographic evaluation of lower uterine segment thickness in patients of previous cesarean section.
OBJECTIVE: To evaluate by ultrasonography, the lower uterine segment thickness of women with a previous cesarean delivery and determine a critical thickness above which safe vaginal delivery is predictable. METHODS: A prospective observational study of 71 antenatal women with previous cesarean delivery and 50 controls was carried out. Transabdominal and transvaginal ultrasonography were used in both groups to evaluate lower uterine segment thickness. The obstetric outcome in patients with successful vaginal birth and intraoperative findings in women undergoing cesarean delivery were correlated with lower segment thickness. RESULTS: The overall vaginal birth after cesarean section (VBAC) was 46.5% and VBAC success rate was 63.5%, the incidence of dehiscence was 2.82%, and there were no uterine ruptures. There was a 96% correlation between transabdominal ultrasonography with magnification and transvaginal ultrasonography. The critical cutoff value for safe lower segment thickness, derived from the receiver operator characteristic curve, was 2.5 mm. CONCLUSION: Ultrasonographic evaluation permits better assessment of the risk of scar complication intrapartum, and could allow for safer management of delivery.
Adult↗
Pelvic umbrella pack for refractory obstetric hemorrhage secondary to posterior uterine rupture.
BACKGROUND: Pelvic hemorrhage continues to be a serious complication of pregnancy and can lead to significant maternal morbidity. The pelvic umbrella pack is a useful alternative to control pelvic bleeding when standard measures fail. CASE: A patient with a previous low transverse cesarean delivery presented in active labor at term. After an uneventful vaginal delivery, defects in the posterior vaginal wall and lower uterine segment were identified. A hysterectomy with repair of the vaginal laceration was performed, but diffuse bleeding persisted. After routine surgical techniques failed to achieve adequate hemostasis, a pelvic umbrella pack was successfully used to tamponade pelvic bleeding. CONCLUSION: In the event of continued hemorrhage after hysterectomy, bleeding that is uncontrolled by surgical intervention may be controlled with a pelvic umbrella pack.
Embolization, Therapeutic↗
Emergency peripartum hysterectomy at the Princess Badeea Teaching Hospital in north Jordan.
OBJECTIVE: To study the prevalence, indications and outcome of emergency peripartum hysterectomy in women delivered at the Princess Badeea Teaching Hospital in North Jordan. METHOD: This is a retrospective study of all cases of emergency peripartum hysterectomy performed between 1st of January 1994 and 31 August 1998. RESULTS: During the study period there were a total of 21 emergency peripartum hysterectomy were performed. The overall incidence was 0.5/1,000 deliveries. The mean age of patients was 34.7 +/- 3.9 years, the median parity was 6 and the mean gestational age was 36.9 +/- 2.01 weeks. There were 19 cases of caesarean hysterectomy. The leading indication for caesarean section was previous caesarean section (89.5%), placenta previa alone (10.5%). It should be noted that 7 cases with previous caesarean section also had placenta previa (41.2%). The main indications for emergency hysterectomy were, abnormally adherent placenta was the leading indication (38.1%), followed by rupture uterus (33.3%), haemorrhage and uterine atony occurred in 14.3% of cases each, maternal complications occurred in 42.9% of cases postoperatively. There were 4 cases of stillbirths and 2 cases of neonatal deaths. CONCLUSION: Peripartum hysterectomy remains a necessary procedure for life saving during abdominal and vaginal deliveries. The procedure itself is usually associated considerable perioperative morbidity. Obstetricians should identify patients at risk and anticipate the procedure and complications.
Adult↗
[Obstetrical hysterectomy].
OBJECTIVE: Obstetrical hysterectomy still remains life saving operation. The aim of study was to determinate the frequency, indications and complications after the operation in the hospital in Zielona Góra, Poland. MATERIALS AND METHODS: A retrospective review based on hospital data of 36 patients undergoing obstetrical hysterectomy over the period of 11 years was undertaken. RESULTS: The incidence of obstetrical hysterectomy during 1990-2001 et the Department of Obstetrics and Gynaecology in the district hospital in Zielona Góra was 1: 593 deliveries. Post partum hysterectomy occurred in 0.021% of normal deliveries and 1.03% of cesarean sections. The most common indications were placenta increta and placenta accreta /61.1%/, followed by uterine atony /13.8%/ and rupture of the uterus /11.1%. The most frequent complications were shock and lesion of the urinary bladder/both 5.6%/. The maternal mortality was 2.8%. CONCLUSIONS: 1. The most common indications for the obstetrical hysterectomy are: placenta's pathologies; uterine atony and rupture of the uterus. 2. Obstetrical hysterectomy is connected with high risk of complications and maternal mortality.
Abruptio Placentae↗
[Urinary bladder displacement (lateroflexio vesicae urinariae) in the sow].
In older gravid sows in the last stage of gestation or after pariturition lateroflexion of the urinary bladder into the space between the vagina and the pelvic wall occasionally occurs. The reposition of the displaced urinary bladder by exerting external pressure either on the vulva or the perineum is usually unsuccessful. Only after the bladder has been emptied by a catheter spontaneous reposition does occur. In two cases displacement of the urinary bladder occurred immediately after normal pariturition. In both cases relapses were observed after the removal of the implanted balloon catheter. Both sows had the urinary balloon catheter reinserted and it was left in place until the weaning of the piglets. There were no complications during the whole lactation period. Both sows reared their piglets and could then be slaughtered.
Animals↗
[Direct fetal electrocardiography in umbilical cord complications and congenital heart abnormalities].
The modern obstetrics allows with help of electronical control a prenatale and intranatale state-diagnosis of the fetal heart. By use of direct fetal electrocardiography is it possible under consideration of QRS-deformations and ST-segment-depressions to add a suspicious diagnosis, so that can avoid dangerous complications of the umbilical cord or in case of absence of such complications can early detect congenital heart diseases.
Asphyxia Neonatorum↗
Genetic heterogeneity of schizophrenia.
The cumulative evidence from over a century of research overwhelmingly implicates genes in the etiology of Schizophrenia. Twin studies consistently find higher rates of schizophrenia among cotwins of monozygotic compared with dizygotic twins and adoption studies show that familial transmission is mediated by genetic, not adoptive relationships. Nevertheless, the hunt for schizophrenia genes with molecular genetic technologies has been disappointing. Although the available literature suggests that cytogenetic abnormalities cause some cases of schizophrenia, these abnormalities must account for only a small fraction of all schizophrenia. Attempts to scan the entire genome with DNA markers spaced at regular intervals have failed to produce unequivocal linkage findings. Notably, several groups have reported findings suggestive of linkage to chromosome 22 and other work provides weak evidence of a gene on the sex chromosomes. The search for schizophrenia genes has been complicated by its unknown mode of transmission, the possibility of phenocopies and genetic heterogeneity.
Female↗
Obstetric complications and physical size of offspring of schizophrenic, schizophrenic-like, and control mothers.
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Adult↗
Anesthetic considerations for complicated obstetrics. I. A retrospective study of 527 twin deliveries.
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Anesthesia, Conduction↗
[Season of birth, obstetric complications and schizophrenia].
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Adolescent↗
Obstetric complications in siblings of Japanese schizophrenics: data from the Maternal and Child Health Handbook.
Although the precise etiology of schizophrenia remains unknown, the development of schizophrenia has been associated with a history of obstetric complication (OC). Furthermore, some studies show structural and functional brain abnormalities in the unaffected siblings of schizophrenics. In this study the perinatal histories of 18 unaffected siblings of schizophrenics and 15 unrelated healthy controls, as detailed in their mothers' Maternal and Child Health Handbook records, were retrospectively analyzed. Records were scored for obstetric complication by the method developed by [Parnas, J., Schulsinger, F., Teasdale, T.W., Shulsinger, H., Feldman, P.M., Mednick, S.A., 1982. Perinatal complications and clinical outcome within the schizophrenia spectrum. Br. J. Psychiatry 140, 416-420]. The authors found the sibling group had greater pregnancy and birth complication (PBC) frequency, severity and total scores than the control population.
Female↗
Association between psychotic disorder and urban place of birth is not mediated by obstetric complications or childhood socio-economic position: a cohort study.
BACKGROUND: Although urban place of birth has been identified as a risk factor for schizophrenia, the extent to which this association is mediated by socially patterned risk factors such as obstetric complications and childhood socio-economic position is unclear. The diagnostic specificity of the association within the clinical psychotic syndromes is also unclear. METHOD: A population cohort of 696025 males and females, born in Sweden between 1973 and 1980 and with linked birth and socio-economic data was followed up from age 16 for up to 9.8 years. Hospitalized cases of schizophrenia and other non-affective psychosis were identified from the Swedish Inpatient Discharge Register. We examined associations of these disorders with a three-level measure of urbanicity of birthplace before and after controlling for measures of foetal nutrition, obstetric complications and level of maternal education. RESULTS: Urban compared to rural birthplace was associated both with increased risk of adult onset schizophrenia (hazard ratio 1.34, CI 0.91-1.96) and other non-affective psychoses (hazard ratio 1.63, CI 1.18-2.26). None of these associations was greatly affected by adjustment for obstetric complications or maternal educational level. In the group of other non-affective psychoses urban-rural differences in disease risk were strongest among those born in the winter months. CONCLUSION: Urbanization of birthplace is associated with increased risk of non-affective psychosis but this is not confined to narrowly defined cases. The magnitude of the association in Sweden is lower than that reported in other studies. Causal factors underlying this association appear to operate independently of risks associated with obstetric complications and parental educational status.
Adolescent↗
Physical sequelae of caesarean section.
The complications and recovery from caesarean section are dominated by the medical condition of the woman pre-operatively. Evidence regarding risks directly attributable to the caesarean section is scanty, and often derived from obstetric practice that differs from the current day. Mortality associated with the procedure is anything up to five times that for vaginal delivery, with emergency caesarean section associated with almost twice the risk of elective procedures. Data regarding placenta praevia and placenta praevia-accreta come from population series where antibiotics were not routinely used for caesarean section, but there is no doubt that previous caesarean section increases the risk of both. Antibiotic and thromboprophylaxis at the time of caesarean section decrease morbidity in the index pregnancy, but can also reasonably be expected to reduce future pregnancy complications.
Adult↗
Coding of perineal lacerations and other complications of obstetric care in hospital discharge data.
OBJECTIVE: To assess the validity of obstetric complications, including the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Core Measure on perineal lacerations, in the California Patient Discharge Data Set. METHODS: We randomly sampled 1,611 deliveries from 52 of the 267 hospitals that performed more than 678 eligible deliveries in California in 1992-1993. We compared hospital-reported complications against our recoding of the same records. RESULTS: Third- and fourth-degree perineal lacerations were reported accurately, with estimated sensitivities exceeding 90% and positive predictive values exceeding 65% (weighted to account for the stratified sampling design) or 85% (unweighted). Based on in-depth review of discrepant cases, we estimate the actual positive predictive value at over 90%. Most coding discrepancies were between no injury and first degree, or between first and second degree. Most postpartum complications, including urinary tract and wound infections, endometritis, anesthesia complications, and postpartum hemorrhage were reported with less than 70% sensitivity, but at least 80% positive predictive value. Composite measures from HealthGrades and Solucient, which include these complication codes, also suffer from high false-negative rates. CONCLUSION: Third- and fourth-degree perineal lacerations are accurately reported on hospital discharge abstracts, confirming the validity of related quality indicators sponsored by the Agency for Healthcare Research and Quality and JCAHO. Administrative data seem less useful for monitoring other in-hospital postpartum complications.
Adult↗
Treatment of recurrent attacks of supraventricular tachycardia during pregnancy causing complications in both mother and fetus.
Cardiac arrhythmias including supraventricular tachycardia are commonly encountered during pregnancy. The case of a young Indian woman with recurrent attacks of supraventricular tachycardia during pregnancy which was managed with adenosine and verapamil is reported. The possible mechanisms of maternal and fetal complications are discussed.
Adenosine↗
[Strong relationship between the course of the first pregnancy, delivery and puerperium and that of the following].
OBJECTIVE: To evaluate the significance of the course of a first pregnancy, delivery and puerperium (episode) for the course of a second episode. DESIGN: Retrospective cohort analysis. METHOD: Data from 3591 pregnancies, deliveries (3624 children) and puerperium of women from the Dutch town of Urk in the period 1986-1995 were analysed. RESULTS: The study group consisted of 910 nulliparous women. Of these, 387 (group 1) had experienced an uncomplicated first pregnancy-delivery-puerperium episode and 523 (group 2) a complicated one. In the study period, 77.3% of the women in group 1 and 59.8% of the women in group 2 gave birth for a second time. The course of the second episode was uncomplicated in 74.6% of group 1 and 46.3% of group 2. This difference was significant (p < 0.0001). The percentage of home deliveries in groups 1 and 2 was 80.3% and 50.5% respectively (p < 0.0001). The percentage of operative deliveries (vaginal and abdominal) was 1.3% and 8.6% respectively (p = 0.0008). No significant differences in perinatal outcome and postpartum referrals were found. Sixty-two of the 313 women with a complicated first episode had a primary indication for hospital delivery for a second partus, based on the outcome of the first episode. Even when these women were excluded, the differences in outcome as described were significant. CONCLUSION: An uncomplicated versus complicated first pregnancy-delivery-puerperium episode was an important prognostic factor with respect to an uncomplicated or complicated secondary episode respectively.
Adolescent↗
Intracervical prostaglandin E2 gel for cervical ripening.
Forty-five women with an unfavourable cervix (cervical score less than 3) and an obstetric indication for delivery were given intracervical prostaglandin E2 (PGE2) gel 0.5 mg/3 g to prime the uterine cervix. Twenty-one women (47%) went into labour after PGE2 gel application only. In 13 women (29%) the cervical score sufficiently improved within 12 hours and labour was successfully induced with intravenous oxytocin. The rate of adverse effects was notably: there were two uterine ruptures, the rate of cesarean sections was 33%, hypertonic uterine contractility 25%, premature rupture of membranes 16%, and neonatal asphyxia 21%. In our experience, cervical ripening with PGE2 gel, although efficient, may also bring about complications, which appear partly iatrogenic. Therefore, a critical evaluation of indications and the risk/benefit ratio is required.
Cervix Uteri↗