26
|
Khatuja R, Mehta S, Shree S, Arora N. Repeat caesarean: time to re-evaluate the current practice. Arch Gynecol Obstet 2016; 294:1337-1338. [PMID: 27671012 DOI: 10.1007/s00404-016-4207-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/13/2016] [Indexed: 11/30/2022]
|
27
|
|
28
|
Souverville FM. A Glorious VBAC. MIDWIFERY TODAY WITH INTERNATIONAL MIDWIFE 2016:58-59. [PMID: 29912517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
|
29
|
Nishikawa A, Matsuzaki S, Mimura K, Kanagawa T, Kimura T. Short interpregnancy interval after B-Lynch uterine compression suture: a case report. CLIN EXP OBSTET GYN 2016; 43:434-436. [PMID: 27328508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE The influence of the B-Lynch suture technique on subsequent fertility and pregnancy outcomes is not clear. In the present report, the authors describe the case of a very short interpregnancy interval following the successful placement of a B-lynch suture and discuss the associated problems. MATERIALS AND METHODS A 33-year-old-woman underwent cesarean section after undergoing artificial induction of labor and subsequent atonic postpartum hemorrhage. Placement of a B-Lynch brace suture successfully stopped the bleeding and preserved the uterus. The patient became unexpectedly pregnant only four months later, making the present case the shortest reported interpregnancy interval after a surgery involving the B-Lynch suture. CONCLUSION In the present case, fertility was not affected, and obstetric complications (abortion, fetal growth restriction, preterm delivery, and placenta previa) were not observed. Adhesions between the abdominal wall and the surface of the uterus along the previous B-Lynch suture line were observed and irregular, large blood vessels were observed on the surface of the uterus. Further reports are expected to determine the influence of the B-Lynch brace suture technique on the subsequent pregnancy.
Collapse
|
30
|
Moroz L, DiNapoli M, D'Alton M, Gyamfi-Bannerman C. Surgical speed and risk for maternal operative morbidity in emergent repeat cesarean delivery. Am J Obstet Gynecol 2015; 213:584.e1-6. [PMID: 26144412 DOI: 10.1016/j.ajog.2015.06.055] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/13/2015] [Accepted: 06/25/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether surgical speed is associated with maternal outcomes in women who have a history of previous cesarean delivery (CD) and who require emergent delivery. STUDY DESIGN This is a secondary analysis of a multicenter, prospective observational study of women with a history of previous CD. Women who attempted a vaginal birth after CD and required emergent CD were dichotomized into those with a skin incision-to-fetal delivery time of ≤2 min (I-D ≤2) or >2 min (I-D >2), based on the mode I-D. Rates of composite maternal complications and specific surgical complications were compared. RESULTS Seven hundred ninety-three women had an emergency repeat CD: 108 women (13.6%) had I-D ≤2, and 685 women (86.4%) had I-D >2. The composite of maternal morbidity occurred in 36% of women with I-D≤2 and 23% with I-D>2 (P < .01). Women with I-D ≤2 had higher odds of intraoperative transfusion, uterine artery ligation, and broad ligament hematoma. In a multivariable regression model, the only variable that remained associated with maternal outcome was I-D (relative risk, 1.66; 95% confidence interval, 1.23-2.23). There was no difference in the incidence of neonatal acidemia between groups. CONCLUSION Among women who underwent emergent repeat cesarean delivery, surgical speed was associated with an increased risk for maternal complications.
Collapse
|
31
|
Creanga AA, Bateman BT, Butwick AJ, Raleigh L, Maeda A, Kuklina E, Callaghan WM. Morbidity associated with cesarean delivery in the United States: is placenta accreta an increasingly important contributor? Am J Obstet Gynecol 2015; 213:384.e1-11. [PMID: 25957019 DOI: 10.1016/j.ajog.2015.05.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 03/16/2015] [Accepted: 05/02/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The purpose of this study was to examine cesarean delivery morbidity and its predictors in the United States. STUDY DESIGN We used 2000-2011 Nationwide Inpatient Sample data to identify cesarean deliveries and records with 12 potential cesarean delivery complications, including placenta accreta. We estimated cesarean delivery morbidity rates and rate changes from 2000-2011, and fitted Poisson regression models to assess the relative incidence of morbidity among repeat vs primary cesarean deliveries and explore its predictors. RESULTS From 2000-2011, 76 in 1000 cesarean deliveries (97 in 1000 primary and 48 in 1000 repeat cesarean deliveries) were accompanied by ≥1 of 12 complications. The unadjusted composite cesarean delivery morbidity rate increased by 3.6% only among women with a primary cesarean delivery (P < .001); the unadjusted rate of placenta accreta increased by 30.8% only among women with a repeat cesarean deliveries (P = .025). The adjusted rate of overall composite cesarean delivery morbidity decreased by 1% annually from 2000-2011 (P < .001). Compared with women with a primary cesarean delivery, those women who underwent a repeat cesarean delivery were one-half as likely (incidence rate ratio, 0.50; 95% CI, 0.49-0.50) to experience a complication, but 2.13 (95% CI, 1.98-2.29) times more likely to have a placenta accreta diagnosis. Both cesarean delivery morbidity and placenta accreta were positively associated with age >30 years, non-Hispanic black race/ethnicity, the presence of a chronic medical condition, and delivery in urban, teaching, or larger hospitals. CONCLUSION Overall, cesarean delivery morbidity declined modestly from 2000-2011, but placenta accreta became an increasingly important contributor to repeat cesarean delivery morbidity. Clinicians should maintain a high index of suspicion for abnormal placentation and make adequate preparations for patients who need cesarean deliveries.
Collapse
|
32
|
Miller ES, Grobman WA. Obstetric outcomes associated with induction of labor after 2 prior cesarean deliveries. Am J Obstet Gynecol 2015; 213:89.e1-89.e5. [PMID: 25683964 DOI: 10.1016/j.ajog.2015.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 01/08/2015] [Accepted: 02/09/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to determine whether, in the setting of induction, obstetric outcomes differ based on the number of prior cesarean deliveries (CD) and to determine whether women with 2 cesareans undergoing induction face increased risks of adverse outcomes compared to women undergoing a repeat CD. STUDY DESIGN This is a secondary analysis of a 4-year multicenter prospective cohort. Women with 1 or 2 CD were included. Frequencies of vaginal birth after cesarean as well as maternal and neonatal complications were compared among women with 1 CD undergoing induction, women with 2 CD undergoing induction, and women undergoing repeat CD with 2 cesareans. RESULTS Of the 10,262 women included in this study, 4100 (40.0%) underwent an induction after 1 CD, 152 (1.5%) underwent an induction after 2 CD, and 6010 (58.6%) had a repeat CD after 2 CD. In women undergoing induction, the chance of vaginal birth after cesarean was no different in women with 2 compared to 1 prior CD (65% vs 69%, P = .28). Similarly, composite maternal (adjusted odds ratio [aOR], 1.2; 95% confidence interval [CI], 0.6-2.3) and neonatal (aOR, 1.1; 95% CI, 0.7-1.7) outcomes were not different between the 2 groups. In women who had 2 prior CD, undergoing an induction carried similar composite adverse maternal and neonatal outcomes compared to having a repeat CD (aOR, 0.7; 95% CI, 0.3-2.0; aOR, 1.1; 95% CI, 0.6-2.2). CONCLUSION Labor induction outcomes are similar regardless of whether women have had 1 or 2 CD. After 2 CD, undergoing an induction carries similar maternal and neonatal risks as having a repeat CD.
Collapse
|
33
|
Shorten A, Shorten B. Timing the provision of a pregnancy decision-aid: temporal patterns of preference for mode of birth during pregnancy. PATIENT EDUCATION AND COUNSELING 2014; 97:108-113. [PMID: 25082724 DOI: 10.1016/j.pec.2014.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 06/12/2014] [Accepted: 07/06/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To help identify the optimal timing for provision of pregnancy decision-aids, this paper examines temporal patterns in women's preference for mode of birth after previous cesarean, prior to a decision-aid intervention. METHODS Pregnant women (n=212) with one prior cesarean responded to surveys regarding their preference for elective repeat cesarean delivery (ERCD) or trial of labor (TOL) at 12-18 weeks and again at 28 weeks gestation. Patterns of adherence or change in preference were examined. RESULTS Women's preferences for birth were not set in early pregnancy. There was evidence of increasing uncertainty about preferred mode of birth during the first two trimesters of pregnancy (McNemar value=4.41, p=0.04), decrease in preference for TOL (McNemar value=3.79, p=0.05) and stability in preference for ERCD (McNemar value=0.31, p=0.58). Adherence to early pregnancy choice was associated with previous birth experience, maternal country of birth, emotional state and hospital site. CONCLUSION Women's growing uncertainty about mode of birth prior to 28 weeks indicates potential readiness for a decision-aid earlier in pregnancy. PRACTICE IMPLICATIONS Pregnancy decision-aids affecting mode of birth could be provided early in pregnancy to increase women's opportunity to improve knowledge, clarify personal values and reduce decision uncertainty.
Collapse
|
34
|
Ueshima H, Yoshioka A, Sumi C, Ariyama J, Kitamura A. [Combined use of continuous epidural anesthesia nand transversus abdominis plane block for postoperative management of cesarean delivery in a patient whose previous cesarean deliveries were not properly controlled]. MASUI. THE JAPANESE JOURNAL OF ANESTHESIOLOGY 2014; 63:561-563. [PMID: 24864581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report the successful combined use of continuous epidural anesthesia and transversus abdominis plane block for the management of postoperative pain following a cesarean delivery in a patient whose paralysis and pain were not well controlled after two previous cesarean deliveries. A 28-year-old female patient with no remarkable medical history was scheduled to undergo cesarean delivery at 38 weeks and 3 days of pregnancy. She had undergone cesarean deliveries twice previously, at 23 and 25 years of age. Both of these procedures were concluded using combined spinal-epidural anesthesia. However, in both procedures, the continuous epidural catheter could not be removed within 12 hours because of paralysis of the right leg and sharp pain. Therefore, during the third operation, the concentration of the continuous epidural anesthesia infusion was decreased to prevent complications, and a transversus abdominis plane block was added. The patient experienced no postoperative pain and fewer complications. We think that the combined use of these blocks provided good postoperative pain control with fewer complications.
Collapse
|
35
|
Cox KJ. Counseling women with a previous cesarean birth: toward a shared decision-making partnership. J Midwifery Womens Health 2014; 59:237-45. [PMID: 24773588 DOI: 10.1111/jmwh.12177] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Pregnant women who had a previous cesarean birth must choose whether to have a repeat cesarean or to attempt a vaginal birth. Many of these women are candidates for a trial of labor. Current practice guidelines recommend that women should be thoroughly counseled during prenatal care about the benefits and harms of both a trial of labor after cesarean (TOLAC) and an elective repeat cesarean delivery and be offered the opportunity to make an informed decision about mode of birth in collaboration with their provider. The purpose of this article is to improve the process of counseling, decision making, and informed consent by increasing health care providers' knowledge about the essential elements of shared decision making. Factors that affect the decisions to be made and concepts that are critical for effective counseling are explored, including clinical considerations, women's perspectives, decision-making models, health literacy and numeracy, communicating risk, and the use of decision aids. Issues related to birth sites for TOLAC are also discussed, including access, safety, refusal of surgery, and clinical management.
Collapse
|
36
|
|
37
|
|
38
|
Geoffrion R, Hyakutake MT. Timing cervicovesical fistula repair with repeat cesarean section. Int Urogynecol J 2014; 25:1145-7. [PMID: 24522933 DOI: 10.1007/s00192-013-2323-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 12/28/2013] [Indexed: 10/25/2022]
Abstract
We present a case in which there was optimal management of recurrent cervicovesical fistula. The patient sustained a fistula shortly after a cesarean for cephalopelvic disproportion in the second stage. She underwent an unsuccessful attempt at vaginal repair 3 months postpartum and continued experiencing intermittent urinary leakage through the vagina. She expressed a wish for further childbearing and was counseled to undergo fistula repair at the time of repeat cesarean section. Twenty-seven months after her first delivery, she had a second healthy pregnancy and the repair of her cervicovesical fistula was performed with collagen graft interposition at the time of her elective cesarean section. This case report highlights the importance of surgical timing and comments on various factors that possibly enhance the success of the fistula repair.
Collapse
|
39
|
Holgado CM, Coves S. [Anaesthetic management of caesarean section in pregnancy with diabetes and hypertrophic myocardiopathy with restrictive diastolic dysfunction]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2013; 60:106-109. [PMID: 22565223 DOI: 10.1016/j.redar.2012.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Accepted: 03/08/2012] [Indexed: 05/31/2023]
Abstract
Haemodynamic changes that occur during pregnancy are maximal between 28 and 34 weeks. In the pregnant woman with several associated diseases, such as hypertensive myocardiopathy and pre-gestational diabetes, these changes can lead to a difficult control of pulmonary hypertension and acute pulmonary oedema. We report the case of a pregnant woman with long term type 1 diabetes mellitus who suffered pre-eclampsia in a previous pregnancy, and since then developed hypertensive cardiomyopathy. She was admitted at 30 week gestation for metabolic and blood pressure control, and developed congestive cardiac failure after the administration of betamethasone for foetal lung maturity. A transthoracic echocardiogram showed a non-dilated hypertrophic left ventricle with good systolic function, restrictive diastolic dysfunction and moderate pulmonary arterial hypertension. When her general condition improved, we performed a caesarean section under regional anaesthesia to prevent the complications of pulmonary and systemic hypertension. We present the anaesthetic management and resolution of complications after oxytocin administration.
Collapse
MESH Headings
- Adult
- Anesthesia, Epidural/methods
- Anesthesia, Obstetrical/methods
- Betamethasone/adverse effects
- Cardiomyopathy, Hypertrophic/complications
- Cardiomyopathy, Hypertrophic/drug therapy
- Cardiovascular Agents/therapeutic use
- Cesarean Section, Repeat
- Diabetes Mellitus, Type 1/complications
- Diastole
- Female
- Heart Failure/etiology
- Humans
- Hypertension, Pulmonary/etiology
- Hypotension/chemically induced
- Hypotension/drug therapy
- Infant, Newborn
- Intraoperative Complications/chemically induced
- Intraoperative Complications/drug therapy
- Norepinephrine/therapeutic use
- Oxytocin/adverse effects
- Phenylephrine/therapeutic use
- Pre-Eclampsia/physiopathology
- Preanesthetic Medication
- Pregnancy
- Pregnancy Complications, Cardiovascular/drug therapy
- Pregnancy Complications, Cardiovascular/physiopathology
- Pregnancy in Diabetics
- Supine Position
Collapse
|
40
|
Mölgg A, Lehner R. Maternal outcome in VBAC delivery versus repeat elective cesarean - observations from a retrospective case-control study. Acta Obstet Gynecol Scand 2012; 91:1241. [PMID: 22709271 DOI: 10.1111/j.1600-0412.2012.01486.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
41
|
González de Jesús LP, Barrera García A. [Ectopic pregnancy in cesarean scar]. GINECOLOGIA Y OBSTETRICIA DE MEXICO 2012; 80:295-299. [PMID: 22808860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The ectopic pregnancy within a cesarean scar, is defined as the implantation of the blastocyst outside the endometrium in the site where the histerotomy was made in the previous cesarean. We report a case of a 35-year-old patient, which arrives to the emergency room with 11.3 weeks of gestation. With the diagnostic, prognostic and pleased parity we decide to do block hysterectomy. We describe this case because of its low frequency, but catastrophic consequences that put on danger mothers life. Prevalence is calculated on 1:1800-1226 of all pregnancies (0.15%) and represents 6.15% of de ectopic pregnancies in women with at least one cesarean. They have been published a mayor number of cases during the last decade, probably because of the world increment of cesarean delivery or the earliest diagnostic. We recommend interruption of pregnancy at the moment of diagnosis, to avoid complications.
Collapse
|
42
|
Akbayir O, Alkis I, Corbacioglu A, Ekiz A, Akca A, Cekic S. Exaggerated placental site reaction detected during caesarean delivery: a case report. CLIN EXP OBSTET GYN 2012; 39:234-235. [PMID: 22905472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Exaggerated placental site (EPS) reaction is an exuberant physiologic process in which intermediate trophoblasts infiltrate the underlying endometrium and myometrium at the implantation site. During a caesarean section, we noted a polypoid well shaped smooth lesion, about 3 cm in diameter on the anterior wall of the uterus apart from the placenta. The histopathologic examination revealed an exuberant proliferation of trophoblastic cells in the placental site, a low Ki-67 labelling index and the absence of mitotic activity. Distinguishing EPS reaction from the other intermediate trophoblastic tumours is critical, as the latter may likely involve surgical intervention and/or chemotherapy, although no specific treatment and follow-up is required for EPS reaction. It is necessary to be aware of this pathology and take biopsies from suspicious lesions in the placental site for pathologic examination.
Collapse
|
43
|
Sugaya S, Yahata T, Nishikawa N, Arinami Y, Maruhashi T, Takakuwa K, Tanaka K. Severe Asherman's syndrome complicated with placenta increta conceived by intracytoplasmic sperm injection following hysteroscopic surgery. CLIN EXP OBSTET GYN 2012; 39:547-549. [PMID: 23444767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Although severe Asherman's syndrome is a disease that may cause infertility, pregnancy and childbirth are possible by performing hysteroscopic surgery. However, the obstetrical outcome is not always satisfactory. We report a case where severe Asherman's syndrome occurred following a cesarean section. Hysteroscopic surgery was performed due to secondary infertility, and pregnancy was achieved through a subsequent intracytoplasmic sperm injection. At 23 weeks of gestation, the patient was hospitalized due to the threat of premature labor, and a cesarean section was performed at 29 weeks of gestation after pregnancy-induced hypertension occurred. It was determined to be abnormal adherent placentation such as placenta increta through intraoperative findings, and a cesarean hysterectomy was performed. The pathological diagnosis of the uterus was placenta increta. Due to the risk of complications from placenta increta in pregnancies following hysteroscopic surgery in patients with severe Asherman's syndrome, it is important to realize the high risk involved in such cases during the pregnancy course, and careful perinatal management should be required.
Collapse
|
44
|
Henrich W, Stupin JH. 3D volume contrast imaging (VCI) for the visualization of placenta previa increta and uterine wall thickness in a dichorionic twin pregnancy. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2011; 32:406-411. [PMID: 21080310 DOI: 10.1055/s-0029-1245796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Placenta increta is a rare event in pregnancy, but is associated with serious maternal morbidity and mortality due to life threatening hemorrhage. The incidence has increased due to high Cesarean rates. We describe a case of placenta previa increta in a dichorionic twin pregnancy, which was successfully treated conservatively, to discuss the role of ultrasound, especially 3D VCI and TUI, for diagnosis and conservative management in similar cases. MATERIALS AND METHODS A GE Voluson Expert 730 ultrasound system which provides both conventional 2D imaging and 3D volume acquisitions using VCI and TUI was used for diagnosis and management in a case of placenta increta in a dichorionic twin pregnancy in which the placenta previa increta of the first fetus was left in situ and the other placenta was removed. RESULTS The 3D VCI provided superior resolution of the anterior wall of the uterus, delineating the myometrial thickness in the area of the placental implantation site. With superior image quality, the 3D VCI technique facilitates the evaluation of the myometrial thickness and the depth of placental invasion due to significantly improved enhancement of the contrast and differentiation between various tissues compared to the 2D scan. CONCLUSION We describe for the first time the application of 3D VCI and TUI for the visualization of the depth of placental invasion in such a case. Preoperative ultrasound diagnosis allows appropriate preoperative preparations and the decision to leave the placenta untouched to avoid a probable fatal outcome for the patient.
Collapse
MESH Headings
- Adult
- Cesarean Section, Repeat
- Contrast Media
- Female
- Humans
- Imaging, Three-Dimensional/methods
- Infant, Newborn
- Male
- Myometrium/diagnostic imaging
- Obstetric Labor, Premature/diagnostic imaging
- Obstetric Labor, Premature/therapy
- Placenta Accreta/diagnostic imaging
- Placenta Accreta/therapy
- Placenta Previa/diagnostic imaging
- Placenta Previa/therapy
- Placenta, Retained/diagnostic imaging
- Placenta, Retained/therapy
- Postoperative Care/methods
- Pregnancy
- Pregnancy, Twin
- Prognosis
- Ultrasonography, Doppler, Color
- Ultrasonography, Prenatal/methods
- Uterus/diagnostic imaging
Collapse
|
45
|
Kerckoff-Villanueva HH, Bautista-Melgoza A, Rodríguez-Márquez DM. [Cervical meningocele with filiform connection. Case report]. GINECOLOGIA Y OBSTETRICIA DE MEXICO 2011; 79:497-500. [PMID: 21966848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The meningocele is the least common form of spina bifida cystica and represents less than 10% of cases of this disorder. A case of a female patient aged 26 with a history of two pregnancies and two previous cesarean sections, present pregnancy unplanned, uncontrolled during the first trimester prenatal and without supplementation with folic acid. Family history of consanguinity with her husband (second cousins) and psychomotor reassessed in four maternal cousins. The first follow-up visit the patient was at 34 weeks of pregnancy. The ultrasonographic findings were: cervical meningocele posterior filiform connection between the first and second cervical vertebrae, lateral ventriculomegaly and third and fourth ventricles and hydrocephalus secondary. Cesarean section was performed at 37 weeks gestation and was a newborn male 3.000 g, 52 cm, head circumference of 36 cm, Apgar 8/9, Capurro 37 weeks of gestation. In the posterior cervical region tumor was located a soft 5 x 5 cm with intact skin, adhered to deep planes. Movement of all four extremities without neurological involvement. He referred to the department of neurosurgery for shunt placement and subsequently performed surgical excision of the meningocele.
Collapse
|
46
|
Weber Sánchez A, García-Benítez CQ, Bravo Torreblanca C, Garteiz Martínez D, Carbo Romano R, Vega Rivera F, Ortiz Reyes H. [Case report. Post cesarean section laparoscopic cholecystectomy for hydrocholecystitis]. GINECOLOGIA Y OBSTETRICIA DE MEXICO 2011; 79:230-234. [PMID: 21966811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
BACKGROUND Acute cholecystitis is the second most common surgical emergency in pregnant women. Although laparoscopic cholecystectomy has been described previously in these cases, there is still controversy regarding the most appropriate moment in which to perform the procedure. OBJECTIVE To describe the clinical presentation and management of a female with 36.6 weeks of pregnancy and clinical signs of acute cholecystitis. Cesarean section to deliver a healthy newborn was immediately followed by laparoscopic cholecystectomy without complications. A 10 year literature review complements the analysis and discussion of the case. CLINICAL CASE A 33 year-old female with 36.6 weeks of gestation presented a history of 24 hours with right upper quadrant and epigastric abdominal pain, nausea and vomiting. Symptoms were precipitated by cholecystokinetics and did not subside after expectant and pharmacologic medical treatment. The medical group decided with the patient's consent to interrupt the pregnancy via Cesarean section immediately followed by laparoscopic cholecystectomy. RESULTS After Cesarean section through a Pfannenstiel incision, laparoscopic trocars were placed and cholecystectomy performed without complications. The postsurgical course was favorable and both patient and newborn were discharged on day four. CONCLUSIONS Laparoscopic surgery cholecystectomy during pregnancy and in the immediate puerperium is feasible and safe. These combined procedures: rapid pregnancy interruption followed by a minimal invasive approach gives the benefits of laparoscopic surgery in these patients.
Collapse
|
47
|
Unda-Franco E, Ramírez-Avilés EM, Moreno-de Gante L, González QH. [Caesarean section for ulcerative colitis]. GINECOLOGIA Y OBSTETRICIA DE MEXICO 2011; 79:93-96. [PMID: 21966789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We present a case of a 35-year-old patient with diagnosis of ulcerative colitis that presented failure and complications associated with medical treatment; with a report of a colonoscopy and biopsy of pancolitis with severe activity. The patient was submitted to laparoscopic restorative total proctocolectomy with ileal "J" pouch anal anastomosis. Two months later the ileostomy was reversed. The patient received progesterone at the same time she was receiving immunosuppressive drugs. This was suspended two months after the second colon surgery. The patient did not require treatment with ovulation induction to achieve pregnancy. At the fourth month of gestation, the patient developed a perianal abscess, which was successfully drained. After multidisciplinary assessment in week 38 of gestation, it was decided to perform cesarean birth as a way to not affect the ileal pouch and the anastomosis of the digestive tract. At present time, the patient has had no further complications.
Collapse
|
48
|
Chen HP, Sung WC, Hui YL, Hui CK. Anesthetic management of a repeat cesarean section in a parturient with severe peripartum cardiomyopathy requiring ECMO in a previous pregnancy: a case report. CHANG GUNG MEDICAL JOURNAL 2011; 34:28-33. [PMID: 22490455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
The number of pregnant women with cardiac disease is increasing with improvements in technology. In addition, more people are part of the national health insurance plan. However, there are few reports concerning the best method for anesthesia and mode of delivery in these high-risk patients. We report a 29-year-old woman scheduled for a planned caesarean section, who had a history of severe peripartum cardiomyopathy requiring extracorporeal membrane oxygenation in a previous pregnancy. The patient had regular prenatal care in our obstetric clinic. At 29 weeks' gestation, she developed severe dyspnea. A chest radiograph revealed bilateral pulmonary edema and 2-dimensional echocardiography showed a global hypokinesis and severe valve regurgitation with left ventricular ejection fraction of 41.2%. She had an emergency caesarean section and a cardiovascular surgeon was consulted to stand-by. Anesthesia was induced by ketamine 25 mg, midazolam 2.5 mg and rocuronium 50 mg for rapid intubation. The patient tolerated the procedure well and was extubated on postoperative day 1. She was discharged one week after surgery. Postoperatively, the patient was followed in the obstetric and cardiovascular surgery outpatient departments and at 5 months after surgery she was in good condition without any complaints.
Collapse
|
49
|
Malvasi A, Tinelli A, Cavallotti C, Bettocchi S, Di Renzo GC, Stark M. Substance P (SP) and vasoactive intestinal polypeptide (VIP) in the lower uterine segment in first and repeated cesarean sections. Peptides 2010; 31:2052-9. [PMID: 20692311 DOI: 10.1016/j.peptides.2010.07.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 07/27/2010] [Accepted: 07/27/2010] [Indexed: 10/19/2022]
Abstract
The authors studied the presence of substance P (SP) and vasoactive intestinal polypeptide (VIP) and their related fibers in the lower uterine segment (LUS) in 133 women undergoing cesarean sections (CS) during active labor. These were divided into 2 groups: women undergoing repeat or first CSs. Specimens were collected from the LUS and were evaluated by light microscopy and by immunohistochemistry, for the morphometrical quantification of the SP and VIP fibers in the LUS. The SP amount was higher in the post-CS scar, while the VIP amount decreased: nerve fibers contained an SP amount of up to 13 ± 2.6C.U., while nerve fibers contained a VIP amount of up to 7 ± 1.9 C.U. The SP amount counts 10 ± 1.5% of the total Bodian fibers, and the ratio of the VIP is 10 ± 1.8% of their total amount. In normal conditions only 6.61 C.U. of the Bodian surface is occupied by SP related nerve fibers in contrast to 6.63 C.U. of the total surface by VIP; the amount of SP increased up to 13 ± 2.6C.U., while it decreased in the LUS previous scars. The SP levels are higher in repeat CS, while the VIP levels are reduced in the LUS. The increase of SP is probably linked to the attempt to achieve cervical ripening in a post-CS LUS, with the possible consequences of dystocia during vaginal birth after CS. Nevertheless, the decrease of VIP probably affects the relaxation of the internal uterine orifice, compromising the LUS formation and cervical ripening.
Collapse
|
50
|
Hasegawa H, Sanefuji Y, Kanda T, Kasai H. [A case of post-spinal tinnitus which improved after undergoing epidural anesthesia]. MASUI. THE JAPANESE JOURNAL OF ANESTHESIOLOGY 2010; 59:1254-1256. [PMID: 20960895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
A 34-year-old woman suffering from post-spinal tinnitus for 8 years was scheduled for a cesarean section under epidural anesthesia selected to prevent a deterioration of this condition due to a possible decrease in the cerebrospinal fluid level. Unexpectedly, the tinnitus disappeared completely after the epidural injection of 2% lidocaine 27 ml and following continuous epidural infusion. It is conceivable that moderate quantities of local anesthetics into the epidural space might have acted as an effective method similar to that of epidural physiologic saline injection in order to improve the cerebrospinal pressure.
Collapse
|