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At least 19 recordsLinked to original sources
PubMed1990

Antimicrobial prophylaxis in gynaecological and obstetric surgery.

Gynaecologic and obstetric surgery generally is prone to infections caused by bacteria from vagina. The vaginal flora contains normally more than 40 different microorganisms. Some of them are obligate pathogens, such as Chlamydia trachomatis, Neisseria gonorrhoeae and serogroup B streptococci, for other microbial species, like mycoplasmas and staphylococci, the pathogenicity is uncertain. The vaginal flora is under the influence of a great number of variables, such as endocrine factors, life style, contraception, and the use of tampons/pads. The recent literature on antibiotic prophylaxis in gynaecology and obstetrics is surveyed. The conclusions are: Antibiotic prophylaxis is recommended in: Abdominal hysterectomy (in high risk cases), in vaginal hysterectomy, fertility surgery, elective abortion and miscarriage (in carriers of C. trachomatis or N. gonorrhoeae), in cerclage (in endocervical colonization), Caesarean section (in high risk cases), and premature rupture of membranes. Great importance is attached to the prevention of infection of the neonates, with emphasis on the transmission of serogroup B streptococci and herpes simplex virus. The prevention of postoperative and postpartum urinary tract infections is discussed.

Anti-Bacterial Agents↗
PubMed2006

Urological trauma after gynecological and obstetric surgeries.

OBJECTIVE: Gynecological and obstetric surgeries are not uncommon causes of iatrogenic injury of the urinary tract. Herein, we retrospectively report our experience with these injuries over the last 18 years. MATERIAL AND METHODS: Between 1985 and 2003, 120 females (mean age 34.2+/-13.7 years) were included in this study. The types of injury were as follows: vesicovaginal fistula, n=90; ureterovaginal fistula, n=14, ureteric ligation, n=13, vesicouterine fistula, n=2; and ureterouterine fistula, n=1. Definitive repair of such injuries was performed in all cases, including 10 cases of recurrent vesicovaginal fistulae which were treated by means of augmentation cystoplasty or urinary diversion. All patients were evaluated regarding the time and type of surgical intervention and early and late postoperative complications, including failure of primary repair. RESULTS: Of the 80 cases of vesicovaginal fistulae treated with definitive repair, 12 (13.3%) showed recurrence of the fistula. Early ureteric deligation and early or delayed ureteroneocystostomy or ureteric replacement were successful in all cases with ureteric injury. There was no loss of kidney function following the trauma or its repair. CONCLUSIONS: It is mandatory for gynecologists and obstetricians to pay careful attention to the anatomy of the urinary tract in order to avoid its iatrogenic injury. Endourologic means were successful in enabling first aid management of some of these injuries. Early exploration is indicated in cases of ureteric obstruction that present early after trauma. Augmentation cystoplasty, urinary diversion or ileal replacement are indicated in only a few cases.

Adult↗
PubMed2003

Non-obstetric surgery during gestation: risk factors for lower birthweight.

OBJECTIVE: To assess the risk for preterm birth and low birthweight for women undergoing non-obstetric surgery during gestation. DESIGN: Two perinatal tertiary care centres. POPULATION: Women undergoing non-obstetric surgery during gestation between January 1989 and June 1999. MATERIALS AND METHODS: A chart review was carried out. Cervical cerclages, procedures carried out under local anaesthesia or intravenous sedation, or carried out in combination with Caesarean delivery were excluded. MAIN OUTCOME MEASURES: Preterm birth (<37 weeks), birthweight. RESULTS: A total of 116 of 69 800 women (0.2%) underwent non-obstetric surgery, with 96 women delivering under our care. Procedures were more commonly carried out in the second trimester (53%), versus the first (23%) or third trimester (24%). Surgery in the second trimester resulted in the lowest rate of preterm birth (11%). The overall preterm birth rate was 21% (20/96), with 13 out of 20 (65%) occurring between 35 and 37 weeks. The mean interval from surgery to delivery was 18.7 weeks. Rates of preterm birth were similar for either intra- versus extra-abdominal procedures, or general versus regional anaesthetic. Use of a general anaesthetic was associated with a significant decrease in birthweight (3053 vs 3515 g, P = 0.01) despite similar gestational ages at delivery (37.6 vs 38.6 weeks, P = 0.08). Multiple linear regression controlled for gestational age showed that general anaesthesia, longer surgery duration, and intra-abdominal procedures were all significant independent risk factors for lower birthweight. CONCLUSION: While non-obstetric surgery appears to be relatively safe during gestation, general anaesthesia, longer surgery time, and intra-abdominal procedures are associated with lower birthweights.

Anesthesia, General↗
PubMed1991

Evolution of antimicrobial prophylaxis in obstetric surgery.

Problems concerning antimicrobial prophylaxis in obstetric surgery are reviewed from the first experiences with multiple-dose treatments to the new short-term prophylaxis. With the purpose to evaluate the effectiveness of a short-term scheme, a controlled population of 134 obstetric patients was treated with a double dose of 2 g i.m. of cefotetan. Clinically important infectious complications were not observed.

Adult↗
PubMed1999

Acute pancreatitis after gynecologic and obstetric surgery.

OBJECTIVE: Our goal was to evaluate the prevalence and comorbidity of acute postoperative pancreatitis after gynecologic and obstetric surgery. STUDY DESIGN: We reviewed the Mayo Medical Center surgical database (January 1953-January 1997) to identify all confirmed cases of acute pancreatitis occurring within the standard 6-week postoperative convalescence after obstetric and gynecologic surgical procedures. Pancreatitis as a result of concurrent pancreatic or biliary surgery was excluded. Pertinent clinical data were reviewed. RESULTS: Eleven cases of postoperative pancreatitis were identified, with an overall incidence of 1 in 17,000 surgical procedures. Postoperative pancreatitis was more common after obstetric surgery. Identifiable risk factors were noted in 45% of cases, with occult cholelithiasis the predominant factor. Presenting signs and symptoms were primarily epigastric pain, oliguria, and ileus. Significant morbidity or mortality was noted in 27% of the cases. CONCLUSIONS: Acute postoperative pancreatitis is a rare complication after gynecologic and obstetric surgery. Signs and symptoms of pancreatitis are nonspecific in the postoperative setting. Prompt diagnosis and supportive therapy are essential to minimize morbidity and mortality.

Acute Disease↗
PubMed2003

Anaesthesia for non obstetric surgery in pregnant patients.

Female sex constitutes a great part of population and most women are young in childbearing age and expected to be submitted to emergency or urgent obstetric surgery following traumas or diseases which require immediate treatment. Anesthetic considerations for non obstetric surgery during pregnancy include concern for the safety of 2 patients, the mother and fetus, which will be discussed together with the prevention of preterm labor.

Adult↗
PubMed1995

Incidence of back pain after lumbar epidural anaesthesia for non-obstetric surgery--a preliminary report.

This prospective survey attempt to study the incidence of post-operative back pain after lumbar epidural anesthesia for non-obstetric patterns and the correlation of this symptom with various contributing factors. One hundred and five patients who were given lumbar epidural anaesthesia as the sole anaesthesia for non-obstetric surgery were studied. The choice of equipment, number of attempts at giving the injection, duration of surgery and position of patient during surgery were documented. One week post-operatively, the patients were asked whether they recalled any back pain. The nature, duration and severity of the back pain was documented. Statistical analysis was achieved by using Chi-squared test. Twenty-eight patients recalled "injection site tenderness" post-operatively. The pain was mild to moderate in severity and lasted up to 4 days. None of the studied patients had post-operative "backache". The pain showed no significant correlation with needle size, technique of injection, use of epidural catheter, patient's position during surgery, duration and number of attempts made during epidural injection.

Adolescent↗
PubMed1984

Single-dose ceftriaxone versus multi-dose cefotaxime antimicrobial prophylaxis in gynecologic and obstetrical surgery. Preliminary results of a multicenter prospective randomized study.

This multicenter, prospective and randomized study on 355 patients demonstrates the equal efficacy of two short-term antimicrobial prophylactic regimens in gynecologic and obstetrical surgery involving a single dose of a long-acting cephalosporin, ceftriaxone, in comparison with a multiple cefotaxime dose. Among the cefotaxime and ceftriaxone groups which underwent abdominal hysteroctomy, 15 of 112 (13.4%) and 20 of 97 (20.6%) patients developed infections respectively. Four vaginal hysterectomy patients out of 20 (20%) on cefotaxime regimen and 4 of 25 (16%) who received ceftriaxone, became infected (febrile morbidity, wound infections, bacteriuria and infectious complications at a non-surgical site). Also among the cefotaxime and ceftriaxone groups of emergency or elective cesarean sections the differences on the incidence of infections are not statistically significant.

Adult↗
PubMedDate not supplied

Emergency non-obstetrics surgery during pregnancy.

Female constitute the majority of the population in Nigeria according to the 1991 census. Since most of these are young women in childbearing age, it is to be expected that the need for emergency, non-obstetric surgery will occasionally arise in them. This review article sets out a consideration of the anatomical and physiological factors that influence presentation, diagnosis therapy and outcome in these patients. The various common clinical scenarios are discussed and their outcome reviewed.

Anesthesia↗
PubMed2002

The chapel and the operating room: the struggle of Roman Catholic clergy, physicians, and believers with the dilemmas of obstetric surgery, 1800-1900.

By 1800, the Roman Catholic Church and organized medicine faced the dilemma of how to resolve cases of obstructed births. American physicians usually practiced destructive operations, like craniotomy, in an attempt to save the lives of mothers. The church allowed such operations after the death of the infant. A new technique of surgery, the cesarean operation, offered hope that both patients would survive childbirth. Medical progress, and an emerging Catholic belief that the fetus was human, prompted Catholic physicians to advocate the new operation, and stirred a renewed debate among European theologians on the propriety of craniotomy. In America, the broad Christian tradition promoted by the Catholic Church began to inform medicine on the moral and ethical parameters of surgery. American physicians, for their part, engaged in their own debate on the propriety of the cesarean operation. This article, focusing on the cesarean debate, reveals the intersections of Catholicism and medical progress amid the growth of obstetric surgery from 1800 to 1900.

Abortion, Therapeutic↗
PubMed1994

[Comparison of the analgesic efficacy of nalbuphine and its combination with propacetamol during the immediate postoperative period in gynecologic-obstetric surgery].

This prospective randomized single-blind study compared the efficacy of a combination of propacetamol (2 g) and a low dose of nalbuphine hydrochloride (10 mg) with nalbuphine hydrochloride (20 mg) alone, in a population of 152 white female patients after gynaecologic or obstetrical surgery, for alleviation of postoperative pain in recovery room. The drugs were administered intravenously in case of pain. The population was divided into two groups: group 1 received 20 mg of nalbuphine hydrochloride and group 2 received 2 g of propacetamol combined with 10 mg of nalbuphine hydrochloride. The pain intensity was studied with the visual analogue scale and comparisons use no parametric tests (Mann and Whitney test, Kruskall and Wallis test) and Chi2 test. Groups were similar for age, surgical and anaesthesia procedures and initial pain level. The propacetamol-nalbuphine hydrochloride 10 mg association provided a significantly better analgesia than nalbuphine 20 mg during the first two postoperative hours (p < 0.05). In group 1, the analgesia score decrease was respectively 28 +/- 25 mm (range: 33-75 mm) after 1 h and 31 +/- 25 mm (range: 26-84 mm) after 2 h. In group 2, the decrease was more important: 37 +/- 21 mm (range: 5-84 mm) after 1 h and 42 +/- 23 mm (range: 20-84 mm) after 2 h. Side effects were minimal and similar in both groups (nausea, drowsiness). It is concluded that a propacetamol-nalbuphine hydrochloride 10 mg association provides better analgesia than single dose of 20 mg of nalbuphine. This association convenient analgesia with a decreased dose of nalbuphine.

Acetaminophen↗