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Objectives: To describe the practice of ultrasound-guided TAP in the management of postoperative pain after gyneco-obstetric surgery. Methods: This was a descriptive prospective study carried out at the Gynecology-Obstetrics department of the Ignace Deen National Hospital over a period of three (03) months from February 01, 2020 to April 31, 2020. Results: In total, we collected 95 patients. These patients had a mean age of 30 ± 9.5 years. The ASA I class was the most represented with 76% of the cases and the cesarean was the most performed intervention. Regarding the assessment of the pain score by the simple verbal scale (SVE) postoperatively at rest, the mean SLE scores at H6 were 0.17 ± 0.38; at H12 of 1.15 ± 0.62; at H24 of 0.84 ± 0.51; at H36 0.45 ± 0.52 and at H48 0.09 ± 0.29. On mobilization, the mean pain scores were 0.77 ± 0.51 at H6, at H12 1.89 ± 0.61; at H24 of 1.53 ± 0.56; at H36 of 1 ± 0.29 and at H48 of 0.82 ± 0.44. The majority of our patients (66.3%) had a mobilization time of less than 24 hours. The mean length of stay was 3.1 ± 1.3 days and most patients (82%) were satisfied with the management of their pain by ultrasound-guided TAP block. Conclusion: Ultrasound-guided TAP is an effective technique for the management of postoperative pain in gyneco-obstetrics surgery. Its integration in a context of multimodal analgesia could improve the management of postoperative pain in gynecological obstetrics.

Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8 weeks of gestation, with a misdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36 ± 2 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy.A gravidez heterotópica é definida como o desenvolvimento simultâneo de uma gestação intra- e extra-uterina. A ocorrência de gravidez tripla heterotópica espontânea é uma condição médica excepcionalmente rara. Relatamos o caso de uma jovem com gravidez tripla espontânea, às 8 semanas de gestação, com um diagnóstico errôneo de gêmeos tópicos e apendicite aguda. A gravidez tubária ectópica estava rota e uma salpingectomia foi realizada por laparotomia. A gravidez intrauterina progrediu sem intercorrências. Os bebês nasceram saudáveis por cesariana realizada às 36 semanas de gestação. A gravidez de heterotópicos com ectopia e rotura tubária é um desafio diagnóstico e terapêutico. Um alto índice de suspeita e tratamento oportuno por laparotomia ou laparoscopia podem preservar a gestação intrauterina com um resultado bem sucedido da gravidez tópica.

Objective: The objective of our study was to study the surgical activities carried out in the gynecology-obstetrics department of the CHU-YO (Teaching Hospital Yalgado Ouedraogo) from January 1st 2015 to December 31st, 2015. Patients and Methods: This dealt with a cross-cutting descriptive and analytic study with retrospective data collection. Our study has included the female patients who underwent surgery in the operating room and whose medical records were usable. Results: 45% of female patients admitted in the concerned department underwent a surgery. The average age of patients was estimated at 28.02 years ±7 years with extremes of 13 years and 80 years. Obstetrical surgery has involved 89.9% of cases. Female patients have received a loco-regional anesthesia in 92.7% of cases. Emergency surgical operations accounted for 88.8% and caesarean section was the main surgical operation carried out in 87.1% of cases. The mortality rate of the overall surgical operations was 1.04%. Conclusion: A better availability of labile blood products is more likely to reduce the mortality rate of surgical operations under the threshold of 1%.

Objective: To compare the evolution of the operative site in the presence or absence of an occlusive skin dressing. Patients and methods: Prospective, comparative study that took place at the University Hospital of Brazzaville from January 1st to August 31st, 2016. 120 patients were randomly recruited divided into two groups: A study group consisting of 60 patients without a dressing and a control group consisting of 60 patients. Results: Sociodemographic characteristics were similar in both groups, as well as pre- and intraoperative characteristics. Postoperative complications included parietal infection (3 vs. 4 cases, p > 0.05), one case of disunion, and one case of skin irritation by the plaster in the study group. The duration of healing was shorter in the control group compared to the study group (11 ± 2 days vs. 12 ± 2, p > 0.05). The average cost of care equipment was 3.5 times higher for the group with dressing (5120 FCFA vs. 18620 FCFA, p < 0.05). In the study group, only one patient was afraid of seeing her wound. Patients in the control group were less satisfied, indeed they dreaded the time of removal of the plaster because of the pain.

Background and aims . Endometriosis is a commonly found disorder in women of reproductive age, consisting in the presence of active ectopic endometrial tissue outside of the endometrial cavity. Surgical scar endometriosis is a rare condition representing about 2% of all endometriosis cases. The purpose of this study was to assess the main characteristics, diagnosis tools and therapeutic options in abdominal wall endometriosis (AWE). Methods. We have reviewed a series of fourteen cases with histopathological confirmation of AWE that were managed in our institution. Results . The main characteristic of AWE were emphasiszed, showing that 78.57% of the patients had at least one previous caesarian section and that in only 57.14% out of ol case an accurate diagnosis of AWE was established preoperatively. Conclusion. A direct relationship between gynecological and obstetrical surgery and AWE is well established and as the caesarian section rates increase constantly, the awareness regarding AWE should also be increased.

Parietal endometriosis is a rare clinical entity, whose pathophysiology remains unclear. It occurs most often after gynecological or obstetrical surgery. The clinical picture is relatively unspecific. Medical imaging is not very contributive. Only histological examination of the operative specimen can confirm the diagnosis. Surgical treatment must be wide enough to prevent recurrence. We report two cases of abdominal wall endometriosis occurring on caesarean section scar. Through these two cases, we will highlight the characteristics of this pathology including prognosis, which will help the practitioners in understanding the role of diagnosis and early management of this entity and its prevention during gynecological or obstetrical surgery.

Heterotopic pregnancy (HP) is defined as the simultaneous development of an intra- and an extra uterine gestation. The occurrence of a spontaneous triplet HP is an exceptionally rare medical condition. We report the case of a young woman with spontaneous heterotopic triplets at 8weeks of gestation, with amisdiagnosis of topic twins and acute appendicitis. The ectopic tubal pregnancy was ruptured and a salpingectomy was performed by laparotomy. The intrauterine pregnancy progressed uneventfully. The two healthy babies were delivery by cesarean section at 36 ± 2 weeks of gestation. Heterotopic triplets with ruptured tubal ectopic pregnancy represent a special diagnostic and therapeutic challenge for the obstetrician. A high rate of clinical suspicion and timely treatment by laparotomy or laparoscopy can preserve the intrauterine gestation with a successful outcome of the pregnancy. Resumo A gravidez heterotópica é definida como o desenvolvimento simultâneo de uma gestação intra- e extra-uterina. A ocorrência de gravidez tripla heterotópica espontânea é uma condição médica excepcionalmente rara. Relatamos o caso de uma jovem com gravidez tripla espontânea, às 8 semanas de gestação, com um diagnóstico errôneo de gêmeos tópicos e apendicite aguda. A gravidez tubária ectópica estava rota e uma salpingectomia foi realizada por laparotomia. A gravidez intrauterina progrediu sem intercorrências. Os bebês nasceramsaudáveis por cesariana realizada às 36 semanas de gestação.Agravidez de heterotópicos comectopia e rotura tubária é umdesafio diagnóstico e terapêutico.Umalto índice de suspeita e tratamento oportuno por laparotomia ou laparoscopia podem preservar a gestação intrauterina com um resultado bem sucedido da gravidez tópica.

ObjectiveTo summarise the effects of herbal medications for the prevention of anxiety, depression, pain, and postoperative nausea and vomiting (PONV) in patients undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgical procedures.MethodsSearches of MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and LILACS up until January 2018 were performed to identify randomised controlled trials (RCTs). We included RCTs or quasi-RCTs evaluating any herbal medication among adults undergoing laparoscopic, obstetrical/gynaecological or cardiovascular surgeries. The primary outcomes were anxiety, depression, pain and PONV. We used the Grading of Recommendations Assessment, Development and Evaluation approach to rate overall certainty of the evidence for each outcome.ResultsEleven trials including 693 patients were eligible. Results from three RCTs suggested a statistically significant reduction in vomiting (relative risk/risk ratio (RR) 0.57; 95% CI 0.38 to 0.86) and nausea (RR 0.69; 95% CI 0.50 to 0.96) with the use ofZingiber officinale(ginger) compared with placebo in both laparoscopic and obstetrical/gynaecological surgeries. Results suggested a non-statistically significantly reduction in the need for rescue medication for pain (RR 0.52; 95% CI 0.13 to 2.13) withRosa damascena(damask rose) and ginger compared with placebo in laparoscopic and obstetrical/gynaecological surgery. None of the included studies reported on adverse events (AEs).ConclusionsThere is very low-certainty evidence regarding the efficacy of bothZingiber officinaleandRosa damascenain reducing vomiting (200 fewer cases per 1000; 288 fewer to 205 fewer), nausea (207 fewer cases per 1000; 333 fewer to 27 fewer) and the need for rescue medication for pain (666 fewer cases per 1000; 580 fewer to 752 more) in patients undergoing either laparoscopic or obstetrical/gynaecological surgeries. Among our eligible studies, there was no reported evidence on AEs.PROSPERO registration numberCRD42016042838

To analyse the trend of loss to follow-up over time and identify factors associated with women being lost to follow-up after discharge in three fistula repair hospitals in Guinea., FLWOA, SCOPUS: ar.j, info:eu-repo/semantics/published

Introduction Postoperative nausea and vomiting (PONV) affect approximately 80% of surgical patients and is associated with increased length of hospital stay and systemic costs. Preoperative and postoperative pain, anxiety and depression are also commonly reported. Recent evidence regarding their safety and effectiveness has not been synthesised. The aim of this systematic review is to evaluate the efficacy and safety of herbal medications for the treatment and prevention of anxiety, depression, pain and PONV in patients undergoing laparoscopic, obstetrical/gynaecological and cardiovascular surgical procedures. Methods and analysis The following electronic databases will be searched up to 1 October 2016 without language or publication status restrictions: CENTRAL, MEDLINE, EMBASE, CINAHL, Web of Science and LILACS. Randomised clinical trials enrolling adult surgical patients undergoing laparoscopic, obstetrical/gynaecological and cardiovascular surgeries and managed with herbal medication versus a control group (placebo, no intervention or active control) prophylactically or therapeutically will be considered eligible. Outcomes of interest will include the following: anxiety, depression, pain, nausea and vomiting. A team of reviewers will complete title and abstract screening and full-text screening for identified hits independently and in duplicate. Data extraction, risk of bias assessments and evaluation of the overall quality of evidence for each relevant outcome reported will be conducted independently and in duplicate using the Grading of Recommendations Assessment Development and Evaluation classification system. Dichotomous data will be summarised as risk ratios; continuous data will be summarised as standard average differences with 95% CIs. Ethics and dissemination This is one of the first efforts to systematically summarise existing evidence evaluating the use of herbal medications in laparoscopic, obstetrical/gynaecological and cardiovascular surgical patients. The findings of this review will be disseminated through peer-reviewed publications and conference presentations. Systematic review registration PROSPERO CRD42016042838.

A medicalização do parto, como resultado da medicalização social, tem sido descrita como um processo sociocultural complexo que transforma em necessidades médicas, vivências, sofrimentos e dores antes administradas no próprio ambiente familiar ou comunitário. O objetivo é refletir sobre o excesso de cesarianas no Brasil, em uma perspectiva crítica e propositiva. Dados sobre taxas de cesariana e estudos sobre a preferência das mulheres sobre a via de parto são discutidos com a finalidade de contribuir para o debate sobre autonomia das usuárias do sistema de saúde. A medicalização é uma transformação cultural que influenciou a capacidade de enfrentamento autônomo da experiência de parir, visto que implica em dependência excessiva, heteronomia e consumo abusivo de cesarianas. Além disso, discutem-se as redes e os movimentos sociais como possíveis facilitadores da autonomia das mulheres, na medida em que possibilitam apoio mútuo e compartilhamento de experiências, contribuindo para a construção de relações mais igualitárias entre as mulheres e os profissionais de saúde. A participação nessas redes possibilita a mobilização coletiva das mulheres no sentido de reivindicarem seus direitos junto às diversas instâncias da sociedade. The medicalization of childbirth as an outcome of social medicalization has been described as a complex sociocultural process that transforms the experiences, suffering and pain - which were formerly managed in the family or community settings - into medical needs. The scope of this paper is to reflect upon the excessive number of cesarean sections in Brazil from a critical and objective standpoint. Data on caesarean section statistics and studies on women's preference on the manner of delivery are discussed in order to contribute to the discussion on the empowerment of the health system consumers. Medicalization is a cultural change that influences the empowerment to cope with the experience of giving birth, as it involves excessive dependency on and abuse of cesarean sections. Furthermore, social networks and movements are discussed as possible facilitators of women's empowerment, as they enable mutual support, sharing of experiences and a contribution to the construction of more balanced relations between women and health professionals. Participation of these networks fosters the collective mobilization of women to insist on their rights from society as a whole.

Trata-se de caracterizar a evolução da série histórica quanto ao tipo de parto, normal, cesárea e fórceps, no período de 1960 a 2001, nas três maternidades mais antigas e conveniadas ao Sistema Único de Saúde (SUS) de Juiz de Fora. O método utilizado denomina-se história serial e permite a comparabilidade entre eventos históricos em determinado período de tempo. Foi identificado o aumento de incorporação tecnológica nesta trajetória e o crescente uso da cesariana até 1998, quando se identifica o impacto da portaria nº 2816, proposta pelo Ministério da Saúde, através de inversão dessa tendência com elevação do número de partos normais. A diferenciação constatada do tipo de parto de acordo com a categoria de internação aponta para uma discussão marcadamente política, que diz respeito às relações sociais em que se entrelaçam desigualdades de diversas ordens, entre elas as de gênero e de classe social. Conhecer as desigualdades e problematizar sua existência, traduzida em perfis de morbimortalidade e padrões desiguais de assistência, é precondição para obter o encaminhamento da solução. The historical sequence of the evolution of the choice of birth delivery (normal, cesarean section, and forceps) between 1960 and 2001 was evaluated using data from the three oldest maternity hospitals affiliated to the Brazilian Unified Health System (SUS) in the city of Juiz de Fora, Brazil. The so-called serial history method enables comparisons of historical events over a given time period. Greater incorporation of technology and an increase in cesarean sections were detected prior to 1998, when administrative ruling No. 2816 was proposed by the Ministry of Health, which reversed the trend back to normal birth deliveries. The form of delivery was also associated with the admission category, which points to a decidedly political discussion about social inequalities that are interrelated with diverse variables including gender and social class. Understanding inequalities and discussing their more difficult ramifications, with respect to morbidity, mortality, and unequal standards of care, are preconditions to finding solutions to these ubiquitous problems.

Acquired non-hormonal clitoromegaly is a rare condition and is due to benign or malignant tumours and sometimes idiopathic. Few cases of clitoral abscesses have been reported after female circumcision. We hereby report a case of clitoral abscess causing acquired clitoromegaly following an obstetrical surgery.

Background: The prevention and treatment of obstetric fistula still remains a concern and a challenge in low income countries. The objective of this study was to estimate the overall proportions of failure of fistula closure and incontinence among women undergoing repair for obstetric fistula in Guinea and identify its associated factors. Methods: This was a retrospective cohort study using data extracted from medical records of fistula repairs between 1 January 2012 and 30 September 2013. The outcome was the failure of fistula closure and incontinence at hospital discharge evaluated by a dye test. A sub-sample of women with vesicovaginal fistula was used to identify the factors associated with these outcomes. Results: Overall, 109 women out of 754 (14.5 %; 95 % CI:11.9-17.0) unsuccessful repaired fistula at discharge and 132 (17.5 %; 95 % CI:14.8-20.2) were not continent. Failure of fistula closure was associated with vaginal delivery (AOR: 1.9; 95 % CI: 1.0-3.6), partially (AOR: 2.0; 95 % CI: 1.1-5.6) or totally damaged urethra (AOR: 5.9; 95 % CI: 2.9-12.3) and surgical repair at Jean Paul II Hospital (AOR: 2.5; 95 % CI: 1.2-4.9). Women who had a partially damaged urethra (AOR: 2.5; 95 % CI: 1.5-4.4) or a totally damaged urethra (AOR: 6.3; 95 % CI: 3.0-13.0) were more likely to experience post-repair urinary incontinence than women who had their urethra intact. Conclusion: At programmatic level in Guinea, caution should be paid to the repair of women who present with a damaged urethra and those who delivered vaginally as they carry greater risks of experiencing a failure of fistula closure and incontinence., SCOPUS: ar.j, info:eu-repo/semantics/published

Objectives To show the utility of combining routinely collected data with geographic location using a Geographic Information System (GIS) in order to facilitate a data-driven approach to identifying potential gaps in access to emergency obstetric care within a rural Rwandan health district. Methods Total expected births in 2009 at sub-district levels were estimated using community health worker collected population data. Clinical data were extracted from birth registries at eight health centres (HCs) and the district hospital (DH). C-section rates as a proportion of total expected births were mapped by cell. Peri-partum foetal mortality rates per facility-based births, as well as the rate of uterine rupture as an indication for C-section, were compared between areas of low and high C-section rates. Results The lowest C-section rates were found in the more remote part of the hospital catchment area. The sector with significantly lower C-section rates had significantly higher facility-based peri-partum foetal mortality and incidence of uterine rupture than the sector with the highest C-section rates (P

Endometriosis is the commonest gynaecological problem; it affects 7 to 10% women in reproductive age group. Commonest site being the pelvic organs, extrapelvic presentation in almost all parts of the body have been reported. However umbilical endometriosis has been reported in more than one hundred cases. It was first described by Villar in 1886. Umbilical endometriosis accounts for only 0.5% to 1% of all endometriosis cases. Most of the reported cases occurred in the scar following gynaecological and obstetrical surgery. A few cases of primary umbilical endometriosis have been reported. We report such a rare case of primary umbilical endometriosis and the diagnosis was done by FNAC & the patient underwent wide local excision.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i1.19426

Objective(s) To study the incidence, indications and outcome of reoperations done within 7 days of primary gynecological and obstetrical surgery in a teaching institution in last five years.

This commentary discusses instrumental vaginal delivery (IVD) and the issues experienced with that practice in low resource settings. It states that IVD is a key element of essential obstetric care and the improvement of maternal and neonatal outcomes will require the scaling up of IVD use with the provision of equipment and trained operators to areas where they are currently unavailable.

OBJETIVO: Avaliar o efeito da suplementacao com retinil palmitato sobre os niveis de retinol no colostro, investigando a influencia de variaveis maternas (idade, tipo de parto e estado nutricional bioquimico) sobre esses niveis. METODO:Participaram do estudo 33 nutrizes atendidas na Maternidade Escola Januario Cicco, Estado do Rio Grande do Norte, Brasil. Foram coletadas, nas primeiras horas apos o parto, uma amostra de sangue e uma de colostro. Uma nova amostra de colostro foi coletada 6 horas apos suplementacao materna com 200 000 UI de retinil palmitato. O retinol no sangue e colostro foi determinado por cromatografia liquida de alta eficiencia. RESULTADOS: Os niveis medios de retinol no colostro antes da suplementacao foram de 110,8 ± 82,3 µg/dL, tendo atingido 164,4 ± 106,5 µg/dL apos a suplementacao (P < 0,025). Doze puerperas nao responderam a suplementacao ou tiveram um aumento inferior a 10% nos niveis de retinol no colostro; o nivel de retinol serico dessas mulheres foi significativamente mais baixo do que o daquelas que responderam a suplementacao (P = 0,024). Puerperas com parto cesareo (64%) tiveram niveis menores de retinol no soro (P = 0,036), mas nao no leite, em comparacao a mulheres com parto normal. A idade nao influenciou os niveis de retinol, nem no soro nem no leite. CONCLUSOES: A suplementacao com retinil palmitato foi eficaz na elevacao dos niveis de retinol no colostro, garantindo o fornecimento de quantidade suficiente de vitamina A para satisfazer o dobro das necessidades de retinol do recem-nascido.

Objetivos. Describir las tendencias de la operación cesá-rea (OC) asociadas con factores no clínicos en mujeres queasistieron al Centro de Educación para el Parto (CEPAPAR)en la Ciudad de México. Material y métodos. Se analizóinformación de 992 nacimientos de 847 mujeres, ocurridosentre 1988 y 2000. Se utilizó el método de regresión linealpara identificar el comportamiento de factores no clínicoscon respecto a la tendencia de OC. Resultados. La inci-dencia global de OC fue de 32.8%, con 8% de incrementopromedio anual. El porcentaje de OC se mantuvo por de-bajo de 30% hasta 1994; durante los siguientes años se in-crementó hasta 40%. Al analizar la tendencia de OC enrelación con factores no clínicos se encontró que, a lo largodel periodo 1988-2000, el aumento en la incidencia de laOC fue mayor en nacimientos sin instructora presente, en-tre mujeres primigestas y en hospitales grandes (con másde 50 camas). Conclusiones. Los resultados muestran queel aumento en la incidencia de OC está asociado a factoresno clínicos, como el tamaño del hospital y la presencia deuna instructora. Un modelo de apoyo a mujeres, que cuentecon asesoría, información y presencia de una instructoradurante el trabajo de parto, puede contribuir a disminuir elriesgo de tener una OC innecesaria en poblaciones comola estudiada.¡

OBJETIVO: Estudar os fatores relacionados à preferência por cesariana, em gestantes sem intercorrências. MÉTODOS: Estudo transversal com 156 gestantes, de clínica privada na cidade de Osasco, Estado de São Paulo, no período de outubro de 2000 a dezembro de 2001. As gestantes estavam em idade gestacional de 28 semanas ou mais, sem contra-indicação formal para parto vaginal, no momento da entrevista. Foi aplicado questionário sobre informações sociodemográficas, história obstétrica passada e atual. Perguntou-se à gestante questão específica sobre preferência para o parto. Realizou-se teste do qui-quadrado de Pearson e regressão logística para análise multivariada, com nível de significância de 5%. RESULTADOS: Sessenta e sete (42,9%) gestantes se diziam pouco motivadas para parto vaginal. Na análise multivariada foram estatisticamente significativas as seguintes variáveis: parto vaginal prévio (p

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:56:57Z No. of bitstreams: 1 S0102-311X2005000200025.pdf: 71731 bytes, checksum: e86bfed7005fe046271e98d27538de86 (MD5) Made available in DSpace on 2013-08-22T18:56:57Z (GMT). No. of bitstreams: 1 S0102-311X2005000200025.pdf: 71731 bytes, checksum: e86bfed7005fe046271e98d27538de86 (MD5) Previous issue date: 2005-04-01 Made available in DSpace on 2013-09-30T18:23:36Z (GMT). No. of bitstreams: 2 S0102-311X2005000200025.pdf: 71731 bytes, checksum: e86bfed7005fe046271e98d27538de86 (MD5) S0102-311X2005000200025.pdf.txt: 35567 bytes, checksum: c2036656b348785ede1cd0c60409e940 (MD5) Previous issue date: 2005-04-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:38:05Z No. of bitstreams: 2 S0102-311X2005000200025.pdf: 71731 bytes, checksum: e86bfed7005fe046271e98d27538de86 (MD5) S0102-311X2005000200025.pdf.txt: 35567 bytes, checksum: c2036656b348785ede1cd0c60409e940 (MD5) Made available in DSpace on 2014-05-20T13:38:05Z (GMT). No. of bitstreams: 2 S0102-311X2005000200025.pdf: 71731 bytes, checksum: e86bfed7005fe046271e98d27538de86 (MD5) S0102-311X2005000200025.pdf.txt: 35567 bytes, checksum: c2036656b348785ede1cd0c60409e940 (MD5) Previous issue date: 2005-04-01 Este estudo avalia os fatores maternos e fetais envolvidos na transmissão vertical do HIV-1 em 47 pares de mãe e filho. As variáveis comportamentais, demográficas e obstétricas foram obtidas mediante entrevista; os dados referentes ao parto e ao recém-nascido, dos prontuários das maternidades. Durante o terceiro trimestre de gestação foi realizada a contagem da carga viral materna e dos linfócitos T CD4+. A média de idade foi de 25 anos e 23,4% das gestantes eram primigestas, e o fator comportamental mais prevalente foi não usar preservativos. Dentre as gestantes, 48,9% tinham células CD4+ superior a 500 células/mm³ e 93,6% se enquadravam na categoria clínica A; 95,7% submeteram-se à profilaxia com zidovudina durante a gestação ou no parto, a qual foi ministrada a todos os recém-nascidos; 50,0% delas foram submetidas à cesárea eletiva. Apesar de expostas a vários fatores de risco e protetores, nenhuma criança tornou-se infectada. A transmissão vertical resulta de um desequilíbrio entre os fatores, com predomínio dos de risco sobre os protetores. This study aimed to evaluate maternal and fetal factors related to vertical transmission of HIV-1. Participants included 47 mother-child pairs. Behavioral, demographic, and obstetric data were obtained through interviews. Data related to delivery and newborns were collected from registries in the maternity hospitals. During the third trimester of pregnancy, CD4+ T lymphocytes and maternal viral load were measured. Mean age of the mothers was 25 years and 23.4% of the pregnant women were primigravidae. The most prevalent behavioral factor was lack of condom use. 48.9% of the women presented a CD4+ count greater than 500 cells/ mm³, and 93.6% belonged to clinical category A. 95.7% of the women received zidovudine prophylaxis during pregnancy or childbirth, and the medication was also administered to all the neonates. 50.0% of patients were submitted to elective cesareans. Despite several risk and protective factors, none of the children was infected. Vertical transmission is an outcome of an imbalance among factors, with a predominance of risk over protective factors. Universidade de Marília Departamento de Pediatria Universidade Estadual Paulista Departamento de Pediatria Faculdade de Medicina de Botucatu Universidade Estadual Paulista Departamento de Pediatria Faculdade de Medicina de Botucatu

Este estudo compara os fatores sócio-demográficos, características biológicas das mães e a qualidade da assistência prestada em maternidades do Município do Rio de Janeiro. Participaram da amostra 10.072 gestantes que se hospitalizaram para o parto em 47 instituições selecionadas, no período 1999-2001. Dados foram coletados de entrevistas com as mães no pós-parto e de consulta aos prontuários médicos. Utilizou-se o teste chi2 para analisar a homogeneidade das proporções. São diferenciadas as condições de vida, de atenção ao parto e nascimento no Município do Rio de Janiero, sendo mais favoráveis no grupo social que utiliza os serviços de saúde das maternidades privadas, embora persistindo ali uma excessiva proporção de cesáreas e de transferência de recém-nascidos. O estrato composto pelas maternidades federais e municipais recebe a clientela materna e infantil com maior morbi-mortalidade, oferece acompanhamento de familiares na internação, obtendo das mães uma avaliação da atenção recebida mais positiva do que o outro segmento do SUS. As maternidades do estrato 2, representadas majoritariamente pelas instituições particulares conveniadas com o SUS, são as que mais recusam parturientes, produzindo um retardo no acompanhamento do trabalho de parto. This study compares socio-demographic factors, mothers' biological characteristics, and quality of care at maternity hospitals in the City of Rio de Janeiro, Brazil. A sample of 10,072 post-partum women in 47 hospitals was selected. Data were collected by interviewing mothers in the immediate post-partum and from medical records. The chi2 test was used to analyze homogeneity of ratios. Significant differences were found between patients in public and private hospitals in relation to family support, healthy habits during pregnancy, reproductive history, access to and satisfaction with prenatal care and delivery, and particularly adverse effects in the newborns. Private maternity hospitals showed better results, although they displayed excessive cesarean and neonatal inter-hospital transfer rates. The stratum consisting of public Federal and State maternity hospitals received women with greater morbidity, had lower neonatal transfer rates, and received a more positive assessment by clients of the Unified National Health System (SUS). Private maternity centers contracted out by the SUS were the ones that most refused treatment to patients, leading to delays in patient care for delivery.

Women’s chances of survival during pregnancy and childbirth have greatly improved in Nepal. Sophie Cousins reports.

OBJETIVO: El objetivo del estudio es identificar factores socioeconómicos, gineco-obstétricos y del producto asociados a mortalidad perinatal. MÉTODOS: Se realizó un estudio de casos y controles pareado. Se consideró caso a los nacidos vivos o muertos que nacieron y fallecieron entre las 28 semanas de gestación a los 7 días de vida extrauterina. y control al producto nacido vivo entre las 28 semanas de gestación y los 7 días de vida extrauterina. Los datos se obtuvieron de los expedientes clínicos hospitalarios. Se estudiaron 99 casos y 197 controles. Se hizo un análisis estadístico utilizando Stata 6.0. RESULTADOS La media de edad de la madre fue de 24.82 años y del producto de 37.78 semanas de gestación. El promedio de peso del producto fue de 2,760 gramos. Los factores asociados a mortalidad perinatal fueron: ocupación del padre agricultor (RM ajustada 3,31; IC 95% 1,26-8,66); índice de riesgo obstétrico alto (RM ajustada 10,57; IC 95% 2,82-39,66), antecedente de cesárea (RM ajustada 2,75; IC 95% 1,37-5,51); cinco y más consultas prenatales (RM ajustada 4,43; IC 95% 1.86-10,54); producto pretérmino (RM ajustada 9,20; IC 95% 4,39-19,25). CONCLUSIONES: Los resultados muestran que es necesario implementar medidas de prevención y control que aseguren la identificación del riesgo en las mujeres embarazadas, con el fin de abatir la incidencia de mortalidad perinatal. OBJECTIVE: To identify socioeconomic, gynecological-obstetric and fetal factors associated with perinatal mortality. METHODS: A matched case-control study was carried out. Cases were newborns (born live or dead) that were born and died between 28 weeks gestation and 7 days of life. Controls were live newborns between 28 weeks gestation and 7 days of life. A total of 99 cases and 197 controls were studied. Data were obtained from the corresponding medical charts. Statistical analysis was performed using Stata 6.0 software. RESULTS: Mean maternal age was 24.82 years and mean newborn age was 37.78 weeks gestation with an average birth weight of 2,760 grams. Factors associated with perinatal mortality were: father's occupation as a farmer (adjusted odds ratio (OR)=3.31; 95% CI=1.26-8.66); high obstetric risk index (adjusted OR=10.57; 95% CI=2.82-39.66), cesarean birth (adjusted OR=2.75; 95% CI=1.37-5.51), five or more prenatal visits (adjusted OR=4.43; 95% CI=1.86-10.54) and preterm fetal maturity indices (PEG, APG, GEG) (adjusted OR=9.20; 95% CI=4.39-19.25). CONCLUSIONS: The risk factors associated with perinatal mortality found in the study are consistent with the findings reported in the international literature. These results show that prevention and control measures should be implemented to identify at risk pregnant women in order to lower perinatal mortality.

The number of surgical procedures in gravid women unrelated to pregnancy itself has been increased over years. In such cases, one must keep in mind the responsibility for two patients, the optimization and maintenance of maternal homeostasis, avoiding alterations on uteroplacental perfusion that can bring harm to the fetus. This review had focused on safety to performing these procedures during pregnancy, considering the advances in the prevention and treatment of obstetric and fetal morbidity related to anesthesia. Background and Objectives: Despite research advances, there is still much controversy in the anesthetic management of obstetric patients. Several studies have demonstrated the safety of anesthesia in this group of patients. In this review, an analysis of anesthetics used in clinical practice is proposed, as well as the technique to be chosen and its effects on the mother and fetus in non-obstetric surgery during pregnancy. Content: This revision was made based on the main articles in the literature encompassing the epidemiology, physiological changes during pregnancy, anesthetic management, possible risks to the fetus due to the use of anesthetic drugs, fetal monitoring, and procedures such as fetal surgery and laparoscopic during pregnancy. Conclusion: Non-obstetric anesthesia in pregnant patients has proven to be safe in terms of maternal and fetal outcome, maternal morbidity and mortality, teratogenicity, premature birth and fetal loss.

In the 6-year period from 1 August 1991 to 31 July 1997, at Queen Alia Military Hospital, Amman, Jordan, 1339 caesarean sections were performed out of a total 17 392 deliveries, representing an overall incidence of 7.7%. Indications for the caesarean sections were variable. Whether the operation was a primary or repeat procedure was often a major consideration. Efforts to prevent unnecessary caesarean sections should focus on reducing the frequency of first-time procedures

Las indicaciones para realizar episiotomia en los partos vaginales es un tema controvertido que requere revision en todas partes del mundo. En 1995, en la provincia de Neuquen, Argentina, se elaboraron normas para la atencion del parto de bajo riesgo, una de las cuales recomendaba reservar la episiotomia para los casos de alto riesgo de desgarro. Este estudio de cohortes retrospectivo se diseno con objeto de comparar los criterios que se utilizaron en 1996 como indicacion de episiotomia en los centros de maternidad del subsector publico de esa provincia asi como el efecto de la paridad y otras variables en la frecuencia de esa intervencion. Se examinaron 7 513 registros del Sistema Informatico Perinatal, que representan 70% del total de partos atendidos ese ano. Se excluyeron 830 correspondientes a partos por cesarea. Los 6683 registros restantes se dividieron en ocho grupos segun la institucion donde se atendio el parto. Se calcularon las tasas de incidencia de episiotomia en esos grupos y se realizo una regresion de Poisson a fin de ajustar las tasas por peso al nacer de los ninos, paridad y edad de la madre, y forma de presentacion y de terminacion del parto. Tomando al Hospital Neuquen como base por ser el mas complejo y atenderse alli el mayor numero de partos, dos hospitales tuvieron incidencias de episiotomia correspondientes a 70% (IC95%, 62 a 79) y 67% (IC95%, 57 a 78) de las de ese hospital. Otros dos hospitales tuvieron incidencias mas altas que el Neuquen por 28% (IC95%, 13 a 45) y 17% (IC95%, 2 a 35), mientras que en los hospitales restantes no se observaron diferencias significativas. Mediante regresion estratificada segun el numero de partos vaginales previos, se observo que la variable con mayor efecto en la indicacion de episiotomia fue la paridad. En las nuliparas, las tasas no mostraron diferencias segun el lugar donde se atendio el parto, pero en las primiparas si hubo diferencia, aun mas marcada en las multiparas. Se concluyo que todos los establecimientos incluidos en el estudio realizaban episiotomia casi de rutina en las parturientas nuliparas, que hay diferencias significativas en cuanto a su indicacion en primiparas y que estas se incrementan con la paridad. Esas diferencias parecen indicar que en los centros de maternidad publicos de la provincia de Neuquen se estan siguiendo distintos criterios en la indicacion de episiotomia.

CONTEXT AND OBJECTIVE: As there is little information about fertility outcomes among women following clinical treatment (methotrexate and expectant management) and surgery (salpingectomy) consequent to ectopic pregnancy, we evaluate the results from hysterosalpingography subsequent to treatment. The objective was to evaluate contralateral tubal patency using hysterosalpingography following surgery and clinical treatment of tubal pregnancy. DESIGN AND SETTING: This was a prospective study at the Department of Obstetrics of Universidade Federal de São Paulo, a tertiary center. METHOD: Among 115 patients who underwent hysterosalpingography following surgery and clinical treatment of tubal pregnancy between April 1994 and February 2002, 30 were treated with a single intramuscular dose of methotrexate (50 mg/m²), 50 were followed up expectantly and 35 underwent salpingectomy. RESULTS: The patency of the ipsilateral tube was 84% after methotrexate treatment and 78% after expectant management. In addition, contralateral tubal patency was 97% after methotrexate treatment, 92% after expectant management and 83% after salpingectomy. There were no statistically significant differences between the clinical treatment and surgery groups. CONCLUSIONS: The findings from this study suggest similar contralateral tubal patency rates following salpingectomy, methotrexate treatment and expectant management. CONTEXTO E OBJETIVO: Como existem poucas informações a respeito do futuro reprodutivo das pacientes tratadas de gravidez ectópica através do tratamento clínico (metotrexato e conduta expectante) e da cirurgia (salpingectomia), avaliamos as histerossalpingografias após o tratamento da gravidez ectópica. O objetivo foi avaliar a permeabilidade da tuba contralateral pela histerossalpingografia após o tratamento cirúrgico e clínico da gravidez tubária. TIPO DE ESTUDO E LOCAL: Estudo prospectivo realizado no Departamento de Obstetrícia da Universidade Federal de São Paulo (centro terciário). MÉTODOS: Foram realizadas 115 histerossalpingografias após o tratamento clínico e cirúrgico da gravidez tubária no período de 1994 a 2002, sendo que 30 após o tratamento com dose única de metotrexato (50 mg/m²) intramuscular, 50 após a conduta expectante e 35 após a salpingectomia. RESULTADOS: A permeabilidade tubária ipsilateral foi de 84% após o tratamento com metotrexato e de 78% após a conduta expectante. A permeabilidade da tuba contralateral foi de 97% após o tratamento com metotrexato, 92% após a conduta expectante e 83% após a salpingectomia. Não houve diferença estatisticamente significante entre os grupos de tratamento cirúrgico e clínico. CONCLUSÃO: Os dados deste estudo sugerem que a permeabilidade tubária contralateral é similar após a salpingectomia, o tratamento com metotrexato e a conduta expectante.

Objective: to evaluate the incidence, nature, and treatment of intra-operative, urological injuries encountered in the performance of obstetrical and gynaecological surgical procedures. Setting: this review was conducted in a tertiary care hospital involved in resident teaching. In this setting, there are 1,500 gynaecological surgical procedures, 2,200 deliveries, and 395 Caesarean sections performed per year. Methods: the charts of all patients undergoing gynaecological surgery or Caesarean section between June, 1992 and June, 1994 were reviewed. Charts coded for injury to ureter or bladder were selected for review. Data were obtained about pre-operative diagnosis, surgical procedure, time of recognition of the injury, method of repair, and outcome. Results: there were no urological injuries associated with obstetrical surgery. Sixteen cases of urological injury were identified among a total of 3,147 gynaecological operations: a prevalence of 0.51 percent. Of these 3,147 procedures, 826 were major procedures (prevalence 1.9%), with the risk of ureteric injury (0.24%), and that of bladder injury (1.7%). Risk factors identified were previous abdominal or pelvic surgery and the presence of pelvic disease. Conclusions: careful attention to the exposure of the ureters during surgery and sharp dissection of the bladder from the surgical field, particularly in patients with previous pelvic surgery, may help to decrease the incidence of these injuries.

Non-obstetrical surgery during pregnancy is performed in approximately one in 500 pregnancies. The most common diagnostic indications are appendicitis and cholecystitis. Because normal anatomic and physiologic alterations occurring during pregnancy can mimic the presenting signs and symptoms of intra-abdominal problems requiring intervention, accurate diagnosis and timely surgical intervention can pose challenges ta the physician. The problems with the diagnosis and treatment of non-obstetrical surgical conditions are reviewed, and case examples of appendicitis and cholecystitis are used ta highlight the management approach to the pregnant patient.

O Brasil tem uma das maiores taxas de partos cesáreos do mundo, e esse valor tem aumentado anualmente. O presente estudo teve como objetivo analisar possíveis mudanças na data de nascimento decorrentes desse aumento. Foram obtidos os dados dos 1.933.137 nascidos vivos ocorridos no Município de São Paulo entre 2001 e 2010, divididos segundo tipo de parto e data exata de nascimento. Em 2001, a taxa de cesarianas foi de 48,9%, passando a 56,8% em 2010. O dia da semana com menor número de nascimentos (domingo) aumentou a diferença em relação aos outros dias de 111,4 (IC95%: 101,7 - 121,0) em 2001 para 143,1 (IC95%: 135,0 - 151,3) em 2010. Os dois dias com menos nascimentos (Natal e Dia de Finados), apresentaram diferença estatisticamente significativa em relação aos outros dias do ano (p < 0.05) durante praticamente todo o período (a exceção foi o Dia de Finados em 2009). A data com o maior número de nascimentos (Dia Internacional da Mulher) apresentou diferença significativa em 2005 e 2010. O aumento no número de partos cesáreos tem tido efeito significativo na data de nascimento, o que pode trazer consequências no planejamento administrativo de instituições de saúde. Brazil has one of the highest rates of cesarean births, and the number has been growing annually. The scope of this study was to test the possible consequences arising from this increase on the date of birth. The 1,933,137 live births that occurred in São Paulo, Brazil, from 2001 to 2010 were analyzed by type of delivery and exact date of birth. In 2001, 48.9% of all births were by cesarean section, increasing to 56.8% in 2010. During th is period, the difference between the number of births occurring on Sundays (the day of the week with the lowest number) increased from 111.4 (95%CI: 101.7 - 121.0) in 2001, to 143.1 (95%CI: 135.0 - 151.3) in 2010. The two dates with the lowest number of births (Christmas day and the Day of the Dead), had a statistically significant (p < 0.05) difference from the other days of the year during most of the period (the exception being the Day of the Dead in 2009). The date with the highest number of births (International Women's Day) showed a statistically significant d ifference in 2005 and 2010. The increase in the number of cesarean births has had a significant impact on date of birth, which could have consequences for the administrative planning of health institutions.

Results of the use of a special protocol for evaluation of patients requiring tubal ligation is presented after applied by a multidisciplinary group. The authors conclude that the use of defined parameters of age, parity, marital union duration, number of children alive and the presence of maternal clinical pathology are useful to identify patients with smaller chances of regret after surgery.27% of reproductive-age women in Brazil have chosen surgical sterilization as their contraceptive method. Most of these women who have undergone tubal sterilization opted for cesarean surgery. However, given the young ages of many of these women, many regret having been sterilized. This paper summarizes the experience of a multidisciplinary group in evaluating women who apply for surgical sterilization at the Department of Tocogynecology, Faculdade de Ciencas Medicas, Universidade Estadual de Campinas in Sao Paulo. Detailed descriptions are presented of the medical and social characteristics of cases seen between June 1988 and July 1989. The authors conclude that the use of the defined parameters of age, parity, marital union duration, number of living children, and the presence of maternal clinical pathology are useful in identifying the patients who are least likely to regret undergoing surgical sterilization.

Cornual pregnancy is a rare form of ectopic pregnancy. The incidence is reported as 3% of all ectopic pregnancies accounting 20% of deaths due to ectopic pregnancy. When an unruptured cornual pregnancy is diagnosed, there are a variety of management options. Many successful endoscopic management options for cornual pregnancy have been reported.In this case, cornual resection was performed.The other possible treatment options were reviewed.

Some difficulties have been encountered in treating pregnant patients with choledocholithiasis because of the probable harmful effect of scopic irradiation on fetus when endoscopic retrograde cholangiopancreatography (ERCP) is necessary. In this paper, we present such a patient, in whom endoscopic stone extraction without scopic examination was successfully carried out in the guidance of magnetic resonance cholangiopancreatography (MRCP) before the ERCP procedure.

A 38-year-old lady, with a history of recent caesarean section, was diagnosed with a silent uterine perforation by a copper intrauterine contraceptive device under fluoroscopic examination. The incidence of uterine perforation and the increased risk in the puerperium are discussed. The use of ultrasound as the first line investigation is recommended.

Ruptured uterus is an obstetric catastrophe and results in significant maternal and perinatal morbidity and mortality in Nigeria.To review the incidence and management of ruptured uterus over the 8-year period (2000-2004 and 2007-2009) and analysis of records of cases of ruptured uterus during the period under review in a descriptive study.The incidence of uterine rupture is 1 in 81 deliveries with a contribution of 13.8% to maternal mortality in Ebonyi State University Teaching Hospital, Nigeria. There was high fetal wastage as 99 (97.1%) of the babies died. The highest incidence of ruptured uterus was found in the para 2-4 group. Teenagers constituted 4 (3.96%) of the cases. Majority of the rupture, 69 (65.4%) occurred anteriorly. Fifty-seven (56.4%) had only repair of the rupture done. The greatest complication was septicemia, which occurred in 32 (31.7%) of the patients.The incidence of uterine rupture is very high in our center. It is one of the highest causes of maternal and perinatal morbidity and mortality. There should be a multi-pronged effort aimed at improving the utilization of medical services by the populace and the health institutions offering efficient obstetric emergency care.

The forceps manipulation has been abandoned for these three decades from the emergent procedure for terminating delivery. In this study, the outcome of deliveries done by forceps manipulation was analyzed in 15 term pregnant women at obstetrical ward of Ryotsu Municipal Hospital in order to evaluate the usefulness of forceps delivery as one of surgical procedures for terminating delivery. The outcome was compared with that obtained from deliveries with vacuum extraction or deliveries with no surgical procedure. The results obtained were as follows : 1. Although the laceration of birth canal was observed to be more elongated in patients undergoing forceps manipulation compared with those undergoing vacuum extraction, there were no severe complications such as th 4th degree of laceration or vaginal hematoma. 2. The amount of bleeding at delivery was not significantly different between patients undergoing forceps manipulation and those undergoing vacuum extration. 3. Cencerning neonatal conditions, in cases with forceps manipulation, the rate of appearance of neonatal asphyxia was significantly high compared with cases with vacuum extraction. The severe neonatal asphyxia, however, was observed only in cases with vacuum extraction. 4. There were 5 eases who finally underwent forceps manipulation or cesarean section due to failed vacuum extraction. On the contrary, in all cases with forceps manipulation, an offspring was born with only one or two times of traction. These results indicate the usefulness and reliability of forceps manipulation in emergent procedures for terminating delivery.