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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.

There has been little implementation of enhanced recovery after surgery (ERAS) in obstetrical surgery, but ERAS elements have the potential to be successfully implemented in cesarean delivery (CD). The ERAS CD knowledge transfer and implementation will require multidisciplinary team coordination in the preoperative, intraoperative, and postoperative phases and the development of a formalized ERAS® guideline for ERAS CD. Such a guideline will require pairing with an audit system (e.g., ERAS® Interactive Audit System) to enable teams to review their protocol compliance on a regular basis. The ERAS team (typically comprised of at least a surgeon, anesthesiologist, and nurse) determines where their compliance is low and then is able to focus their efforts on improving compliance, which then translates into improved clinical outcomes.

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

We present a case of difficult anesthesia for obstetrical surgery. The case involved a morbidly obese patient requiring anesthesia for a cesarean section and was punctuated by difficult and ultimately failed neuraxial anesthesia, semi-urgent induction of general anesthesia, and management of the difficult airway.

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

Transversus abdominis plane block has become an important method of postoperative pain management for patients undergoing abdominal surgery but the modest duration is a major limitation. We report the successful use of a novel TAP catheter technique for continuous infusion of levobupivacaine in six gynecologic and obstetric patients. Bilateral TAP catheters were inserted at the end of surgery by ultrasound imaging using a Contiplex ® C needle (B. Braun, Melsungen, Germany) in the Triangle of Petit or in a postero-subcostal level based on the location of the surgical incision. Following negative aspiration, 0.25% levobupivacaine 5 mL was injected. After withdrawing the needle, while holding the over-the-needle catheter in place, bilateral continuous infusion of 0.125% levobupivacaine at 2 mL/h from elastomeric pumps (INfusor SV2, Baxter, France) was started and continued for up to 50 h. Before removal of the catheter, a bolus of 10 mL levobupivacaine 0.25% was administered. Successful analgesia was achieved in all six cases utilizing continuous infusion of levobupivacaine, minimizing the volume required. TAP infusions produce significant opioid sparing and better patient mobility. This technique may be a reliable alternative to neuraxial analgesia in major gynecological and obstetrical surgery.

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.

Resume Objectifs Demontrer la faisabilite de l’insertion du DIU au cuivre au decours de la cesarienne et en evaluer l’innocuite. Patientes et methodes Etude prospective pilote au Centre hospitalier national de Pikine du 15 fevrier au 15 novembre 2012. Ont ete evalues l’efficacite, l’incidence et le spectre des complications et le taux de continuation. Resultats L’insertion d’un DIU TCu 380A a ete effectuee au decours de 46 cesariennes. L’âge moyen des patientes etait de 28 ans. Aucune patiente n’avait utilise de DIU auparavant. Quarante-quatre patientes (97,5 %) etaient revenues a la premiere visite de suivi a M1, 41 patientes (89,1 %) a M3 et 39 patientes (86,9 %) a M6. Le taux de perdues de vue etait de 8,7 %. Les douleurs et les metrorragies etaient rarement rapportees : 2,3 % a M1, 4,9 % a M3 et 7,7 % a M6 pour les metrorragies ; et 6,8 % a M1, 2,4 % a M3 et 5,2 % a M6 pour la douleur. Une seule expulsion a ete enregistree, soit un taux cumule de 2,2 %. Conclusion L’insertion du DIU per-cesarienne comporte un taux d’expulsion acceptable et aucun taux accru d’effets indesirables. Cette technique doit etre vulgarisee.

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

This commentary attempts to address a number of issues raised from a paper on maternal mortality in Zhejiang province which are crucial to understanding of the way that health care in general and maternity in particular happens in the Peoples Republic of China. It discusses Chinas reported progress in health care and the childbearing issues for women.

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.

Resume Introduction Le plan d’action pour la reduction de la mortalite maternelle (MM) se fonde generalement sur les resultats des etudes de recherche realisees dans les structures hospitalieres. Objectifs Determiner et suivre l’evolution du taux de MM de 1998 a 2007 dans une maternite de niveau 3 de la ville de Tunis et en identifier les principales causes. Patientes et methodes Il s’agit d’une etude retrospective menee entre janvier 1998 et decembre 2007. Dans notre service, depuis 1984, les deces maternels sont systematiquement repertories dans un registre. L’information sur le deces a ete recueillie soit sur le dossier d’accouchement, soit sur le dossier d’hospitalisation en reanimation, soit apres autopsie ou encore apres information par la famille ou plus recemment, depuis 1999, par le systeme national de surveillance de deces maternel. Resultats Trente et un deces maternels ont ete colliges durant la periode d’etude. L’âge moyen des patientes etait de 33 ans. Le taux de MM global durant la periode d’etude etait de 56/100 000 naissances vivantes. L’evolution etait marquee par une diminution nette des taux jusqu’en 2003 suivie d’une stagnation, voire meme une augmentation en 2007. Le deces etait lie a une cause obstetricale directe dans 81 % des cas. L’hemorragie etait la principale etiologie, impliquee dans 35,48 % des cas. Les complications de la preeclampsie etaient incriminees dans 19,35 % des cas. Dans cette serie, le taux de transfert etait de 48,38 %. Le deces a ete juge evitable dans 80,6 % des cas. Conclusion L’evolution au fil des annees a montre une diminution nette de la MM. Cependant, plus recemment, une stagnation est observee a un niveau eleve avoisinant 50/100 000 naissances vivantes. De plus, la majorite des deces reste evitable. Des progres restent donc a realiser notamment en matiere d’hemorragie obstetricale grave et de preeclampsie etant donne qu’elles demeurent les premieres causes de deces.

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.

Five countries in sub-Saharan Africa use nonphysicians to perform major emergency obstetrical surgery. In Tanzania, assistant medical officers provide most of this surgery outside of major cities. Questions about the quality of surgery by nonphysicians have kept most African countries from following this example. We reviewed the records of all patients admitted for complicated deliveries to fourteen district hospitals during four months. Among 1,134 complicated deliveries and 1,072 major obstetrical operations, there were no significant differences between assistant medical officers and medical officers in outcomes, risk indicators, or quality. There were significant differences between mission and government hospitals.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 37 - N° 8S1 - p. 405-417

Objective: To determine the advantages of modified a Misgav Ladach method over conventional (Pfannenstiel-Dörffler) cesarean section. Study Design: From October 2002 to March 2005, 217 cesarean sections performed according to a modified Misgav Ladach method (without routine preoperative urinary catheterization, blunt separation of the fascia after a small incision, and unprepared plica vesicouterina) were prospectively compared with 153 randomly selected conventional cesarean sections. Maternal age, parity, gestational age, neonatal birth weight, procedure duration, operative complications and postoperative course were analyzed. Results: The incidence of postoperative fever was 2.30 and 4.57% (p = 0.001), wound seroma 0.46 and 1.96% (p = 0.01), local wound infection 0.92 and 1.96% (p = 0.01), wound dehiscence 0 and 0.65% (NS), anemia 3.68 and 7.84% (p = 0.001), and need of blood transfusion 1.38 and 1.96% (NS) in the modified Misgav Ladach and conventional group, respectively. The mean duration of the operation was 26.24 min with the Misgav Ladach versus 39.41 min with the conventional operation (p < 0.001). The postoperative use of antibiotics and analgesics/antipyretics was significantly lower in the modified Misgav Ladach group (p = 0.001). Conclusion: Study results demonstrated that the modified Misgav Ladach method of cesarean section is associated with faster postoperative recovery, lower morbidity and blood loss, shorter length of operative procedure, lower incidence of operative complications, lesser postoperative use of antibiotics and analgesics/antipyretics, and lower utilization of surgical material. The modified Misgav Ladach method of cesarean section is suitable for emergency and elective procedures, justifying its use in daily routine.

The objective of this study was to determine causes and contributing factors to maternal deaths in a poor rural setting. We included all maternal deaths (N =42), identified from January to September 2002, in a remote area of The Gambia. To gain a comprehensive picture of medical causes and contributing factors a combination of audit procedure and verbal autopsy was applied. The results showed that anaemia (n =12) was the leading cause of death followed by haemorrhage (n =10), eclampsia (n =8) and obstructed labour (n =8). Placental abruption accounted for 9 of the 10 haemorrhage cases. Substandard obstetric care was identified for the majority of deaths. Substantial inadequacies were revealed at the hospital, characterized by operational difficulties and an uncoordinated emergency preparedness, including malfunction of the blood transfusion service, failure to obtain operative delivery, poor birth monitoring and lack of trained personnel, electricity, medical equipment and drugs. Substandard primary care and logistic difficulties within the referral process further complicated the situation. Delay in seeking care by the cases themselves played a less important role. It was concluded that interventions, addressing the profound deficiencies within the health care system and increasing access to emergency obstetric care, are warranted to reduce maternal deaths in a poor setting such as rural Gambia.

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.¡

Induction of labor in resource-limited settings has the potential to significantly improve health outcomes for both mothers and infants. However, there are relatively little context-specific data to guide practice, and few specific guidelines. Also, there may be considerable issues regarding the facilities and organizational capacities necessary to support safe practices in many aspects of obstetrical practice, and for induction of labor in particular. Herein we describe the various opportunities as well as challenges presented by induction of labor in these settings.

To compare the perioperative outcomes of two cesarean section methods, the finger-assisted stretching technique (FAST), based on a modified Joel-Cohen method, with the traditional technique.A retrospective review of the records of 416 women who underwent cesarean sections at Guro Hospital, Seoul, Korea, between May 1993 and December 2001 was performed. Of the 416 women, 283 underwent cesarean sections with FAST and 133 with the traditional technique.Operative time was significantly shorter with FAST (15.3 vs. 42.6 min, P.05), and FAST was associated with lower blood loss (601 vs. 928 mL, P.05) and shorter hospital stay (3.7 vs. 6.5 days, P.05). There were no significant differences in wound infection, voiding difficulty, and postoperative adhesions between the two methods.These results suggest that FAST may be the better technique.

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

In 1700 the Dutch surgeon/medical doctor Abraham Cyprianus (1655/1660-1718) published his Epistola historiam exhibens foetus humani post XXI. menses ex uteri tuba, matre salva ac superstite excisi, a 94-page book in which several remarkable case histories are described and illustrated. The most spectacular case in the book is the accurate and detailed description of the delivery of a dead full-term child (ectopic tubar pregnancy) by a laparotomy he performed in a living woman in December 1694. The woman survived the operation and gave birth to three more children in following years. This remarkable, well-considered, brave and life-saving operation, performed in a time without antisepsis and anesthesia in a domestic situation is seldom mentioned by medical historians describing the history of obstetrics. This particular case is reviewed in this article.

Resume Objectif. – Realiser une revue de la litterature concernant les risques et la prevention des incontinences urinaire et anale survenant apres un accouchement. Methode. – Une revue de la litterature internationale a ete effectuee entre 1999 et 2003 en utilisant le site de la National Library of Medicine et les mots cles : « fecal incontinence and delivery » et « urinary incontinence and delivery ». Resultats. – Cinq cent un articles concernent ce sujet. La plupart sont des etudes retrospectives, dont deux concernent des registres regionaux ou nationaux de tres grande taille. Ces deux etudes analysent 2 886 126 accouchements et ont demontre que les principaux facteurs de risque de dechirure perineale sont : la primiparite, le poids du nouveau-ne, les presentations posterieures, la prolongation de la deuxieme phase du travail et les extractions instrumentales. Les autres etudes ont demontre que des taux d'episiotomie superieurs a 30 % n'ont pas d'impact benefique en terme perineal ; l'episiotomie mediane est deletere et multiplie par 2 a 22 le risque de perinee complet. Seules six etudes controlees randomisees ont ete publiees. Elles concluent au benefice de la kinesitherapie perineale pratiquee pendant la grossesse (diminution du risque d'incontinence urinaire a trois mois de 32 a 20 %, p Conclusion. – Les facteurs de risque des lesions perineales, aujourd'hui bien connus, rendent necessaire la realisation d'etudes, controlees et randomisees « interventionnelles » qui permettront de choisir les meilleures techniques de prevention et de reparation du perinee.

Resume Objectif. – Face a l’accroissement important des taux de cesarienne, nous avons cherche a savoir, par cette etude, si l’on n’a pas fait trop de cesariennes au CHU de Dakar. Patientes et methode. – Etude analytique portant sur les cesariennes realisees au CHU de Dakar en 1992, 1996 et 2001. Ces donnees ont ete collectees de maniere prospective et longitudinale dans le cadre du programme de surveillance epidemiologique de la couverture obstetrico-chirurgicale au Senegal. Pour chaque annee concernee, nous avons analyse les cesariennes ainsi que la mortalite maternelle et perinatale. Nous avons ensuite evalue les indications, d’abord individuellement, puis en les regroupant en trois categories (obligatoires, de prudence et de necessite). Pour eliminer la part du hasard dans les variations observees, nous avons utilise comme test statistique la comparaison des proportions observees avec un seuil de signification α inferieur ou egal a 5 %. Resultats. – Le taux de cesarienne est passe de 12 % en 1992 a 17,5 % en 1996 et a 25,2 % en 2001. Les indications sont largement dominees par la disproportion fœto-pelvienne (avec une moyenne de 31,3 % et des extremes de 26 et 34,9 %) et par la souffrance fœtale (avec une moyenne de 25,2 % et des extremes de 18,9 et 25,7 %). La hausse est statistiquement significative pour les indications en rapport avec la disproportion fœto-pelvienne et la pathologie maternelle. La baisse est quant a elle statistiquement significative pour les indications en rapport avec la souffrance fœtale, l’uterus cicatriciel et la presentation du siege. Le regroupement des indications montre une stabilisation des cesariennes obligatoires autour de 41 %, alors qu’on observe une baisse des cesariennes de prudence de 50 a 37,2 % et une augmentation des cesariennes de necessite de 8,6 a 22,4 %. La mortalite maternelle chez les cesarisees a diminue de 1,4 a 0,8 % mais la morbidite postoperatoire reste elevee, autour de 10 %, essentiellement due a l’infection. L’augmentation considerable du taux de cesarienne n’a pas d'impact significatif sur la mortalite maternelle globale (1411 deces pour 100 000 naissances vivantes en 1992 contre 1394 deces pour 100 000 naissances vivantes en 2001) et sur la mortalite perinatale global (121 deces pour 1000 en 1992 contre 116 deces pour 1000 naissances en 2001). Discussion et conclusion. – Aujourd’hui, il existe une inflation des cesariennes au CHU de Dakar sans qu’il y ait une baisse significative de la mortalite maternelle et perinatale. Le taux encore eleve des complications liees a l’intervention nous incite a inverser la tendance pour revenir a des taux juges plus raisonnables, de l’ordre de 10 a 15 % des accouchements.