[The "gentle caesarean section" - an alternative to the classical way of sectio. A prospective comparison between the classical technique and the method of Misgav Ladach]

OBJECTIVE

A new technical variant of caesarean section was described a few years ago, which is characterised by blunt surgical preparation and simplified seam technique. A prospective investigation compared the differences in the surgery and postoperative process as well as the rate of complications between this Misgav Ladach method and the conventional technique of Sectio. The individual postoperative well-being of the women was recorded by visual analog scales. -

PATIENTS AND METHODS

Women, whom realize the including criterias (first caesarean section, >/= 32. week of pregnancy, one baby), were examined in this study over one year: 105 patients operated with the Misgav Ladach method and 67 conventionally operated patients. The patients were randomized in a function of the first letter of the surname (A-K: Misgav-Ladach method; L-Z: classical technique). -

RESULTS

The surgical time from the cut to the seam was significantly shorter (29.8 vs. 49.3 min; p < 0,001) in the Misgav Ladach group. There were no differences between the two methods in the rate of postoperative complications. The febrile morbidity was equivalent in both groups (7.6 % vs. 9 %), likewise the frequency of postoperative hematomas (3.8 % vs. 3 %). The postoperative period with consumption of analgetics was significantly longer in the group of conventionally operated patients (1.9 d vs. 2.4 d; p < 0.01). The postoperative presentness was estimated significantly better (p < 0,.01) by the patients of the Misgav ladach group - probably caused by the significantly earlier mobilization (p < 0.05). -

CONCLUSION

The surgical technique described by Misgav and Ladach allows a safe execution of the caesarean section and represents an alternative to the conventional method. The duration of operation (cut-seam-time) was significantly shorter. The technique of less traumatising of tissue caused a significantly earlier mobilisation and a significantly shorter requirement of analgetics. The women estimated her postoperative physical condition as better.

Carney complex--an unexpected finding during puerperium

Carney complex is an extremely rare, autosomal dominant, multi-system disorder characterized by multiple neoplasias and lentiginosis. The genetic defect responsible for this complex has been localized to the short arm of chromosome 2 (2p16). The most prevalent clinical manifestations in patients with Carney complex are spotty skin pigmentation, skin and cardiac myxomas, Cushing's syndrome and acromegaly. Here we report the case of a 31-year-old woman with a spontaneous pregnancy. At 32 weeks of gestation, she was admitted to our Department of Obstetrics with hypertension and severe back pain. In addition, she had unusual pigmentation and typical cushingoid features. One day after admission, the pregnancy was terminated by emergency cesarian section because of preeclampsia and pathological CTG. During the postoperative period the severe back pain persisted, and radiographic evaluation revealed a collapse of L(2)/L(3) with severe osteopenia. A CT scan showed a mass in the right suprarenal area. Histopathological examination revealed a primary pigmented nodular adrenocortical disease. After biochemical confirmation of the diagnosis of Cushing's syndrome, it was recognized that the patient met the diagnostic criteria for Carney complex.

[Life situation of parents of twins and triplets: a qualitative study]

BACKGROUND

Starting in the middle of the 1980s, an increasing incidence of multiple pregnancies in Germany has been reported, with assisted reproduction mainly contributing to this increase. In the management of multiple pregnancies, the main focus is on optimising the obstetric care. The difficult socio-economic and psychosocial situation of parents of multiples, however, is often underestimated.

METHODS

The present study examines the life situation of parents of twins and triplets using focus groups as a qualitative research method. Nineteen mothers and fathers of twins and triplets were interviewed in four focus groups. Main topics were the parental reaction to the diagnosis of multiple pregnancy, the first time at home with the multiples, special situations and wishes and ideas for a better care during multiple pregnancy.

RESULTS

The diagnosis of multiple pregnancy was made at early gestational age, with the parental reactions being described between "happiness" and "shock". With this diagnosis, however, the future parents feel alone. Caring for the babies is leading to the limits of parent's ability to take stress. Marital problems and social isolation are discussed controversially. Exceptional situations such as illness of the mother require fast and un-bureaucratic solutions.

CONCLUSIONS

The interviews suggest that special problems of multiple parenthood such as social isolation, marital and psychic problems are not necessarily related to higher order multiples or handicapped children. It appears to be essential to offer a more individual care for women expecting multiples, whereas the main resource for improving care is in providing contact and information possibilities.

A study of fetal macrosomia

We describe the maternal characteristics in pregnancy with fetal macrosomia, fetal and maternal complications related to macrosomia, and the risk of impaired glucose tolerance. The study is based on a comparison of maternal and neonatal data in 956 cases of fetal macrosomia (birthweight > or =4000 g) in non-diabetic pregnancy with data in a control group of 6407 mothers with non-macrosomic infants (birthweight 3000-3999 g). The main factors investigated were maternal age, weight, parity, gestosis rate, maternal and fetal birth injuries, maternal oral glucose tolerance test results and umbilical blood insulin levels. Macrosomic infants occurred in 9.1% of all deliveries. Mothers delivering macrosomic infants were significantly older, of higher parity and of greater weight than mothers of the control group. Fetal macrosomia was associated with a higher frequency of gestosis, operative deliveries, birth injuries and postpartum haemorrhages. 26.2% of the mothers had abnormal of oGTT results. The macrosomic infants were more often male and had a significantly higher risk of shoulder dystocia and birth injuries. No essential differences could be observed in the Apgar-scores and umbilical artery pH values. 34% of macrosomic infants had higher insulin levels in umbilical blood.

[Müllerian adenosarcoma of the uterus. A case report]

A case of Müllerian adenosarcoma of the uterus is described. The patient, an 81-year old female, was treated in hospital for vaginal bleeding in 1993. She was diagnosed as having a tumour of the uterus. The patient underwent an abdominal hysterectomy with bilateral salpingo-oophorectomy. We found a polypoid intrauterine tumour which had led to a swelling of the cavum and cervical canal. Histologically a Müllerian adenosarcoma was diagnosed. The tumour consisted of a benign glandular component and an mesenchymal component in the form of a low differentiated pleomorphic rhabdomyosarcoma.

[Prenatal growth of children of epileptic mothers]

In this study 67 children of 59 females with epilepsy and on anticonvulsants were investigated. Children of epileptic women on medication with Primidon are of lower weight and have smaller heads than children from epileptic mothers without medication and children from parents without epilepsy.

[Epilepsy and pregnancy--results of interdisciplinary cooperation]

A total of 19 female epileptics were jointly counselled, cared for and delivered during 21 pregnancies. Special aspects that must be taken into account during pregnancy in epileptics are described. Due to changes in the pharmacokinetics of anti-epileptic drugs, plasma level checks must be performed every four weeks during early pregnancy. The possible teratogenic effects of anticonvulsants and other factors tending to increase the malformation rate are discussed. An explanation is given for the use of prophylactic folic acid and vitamin k treatment in connection with anti-epileptic therapy. Breast feeding has not only proved advantageous from the nutritional standpoint but also helps withdraw the new-born, who is habituated to anticonvulsants, from the drugs without negative symptoms. The benefits of counselling prior to pregnancy and general questions relating to women who are prone to seizures while they are of child-bearing age is discussed.

[Undifferentiated cell leukosis in pregnancy]

The appearance of an undifferentiated cell leucosis during pregnancy is relatively rare. However, it is increasingly more frequently to be reckoned with this fact, since the rate of leucosis is increasing. On account of the extraordinary situation in the individual case may be difficult diagnostic and above all therapeutic decisions which are discussed with the help of the represented case.