International journal of gynaecology and obstetrics : the official organ of the International Federation of Gynaecology and Obstetrics
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Int J Gynaecol Obstet · Mar 1980
Bowel injury in septic abortion: the need for more aggressive management.
An analysis of bowel injury in cases of septic abortion treated over a six-year period at the University of Nigeria Teaching Hospital at Enugu is presented. Seventy-three percent (11/15) of the patients who underwent laparotomy had concomitant injury to the bowels. Overall, 16.4% of the 67 patients with septic abortion had intestinal injuries (this does not include the patients who died as a result of fulminating peritonitis before surgery could be performed). ⋯ When a dysfunctioning colostomy was raised, the mortality was nil. In patients who had simple closure of the perforation and in those who had primary resection and anastomosis, mortality was 66.6%. The importance of performing laparotomy much sooner than usual is discussed.
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In spite of great strides in obstetrics, maternal mortality has been completely eliminated. Possible changes in the causes of mortality are examined for three periods of time (1954-1961, 1962-1971 and 1972-1976). The overall incidence was 3.6/10 000, changing through the three periods from 4.9 to 4.3 and finally to 3.0/10 000. ⋯ Cesarean section was involved in ten of 23 cases in which the death was directly related to the pregnancy and delivery. In six patients there was a rupture of the uterus. The number of preventable deaths has decreased steady, but research into the problem of vascular accidents and dampening of the enthusiasm for cesarean sections may further improve the situation.
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Int J Gynaecol Obstet · Mar 1979
Cesarean section with regional anesthesia using an extendable epidural block.
Epidural analgesia was used for 86 deliveries by cesarean section. The placement of a catheter in the epidural space allowed adjustment of the extent of the block so that supplementary analgesia was required in only six patients. ⋯ Symptomatic hypotension was avoided or corrected by the intravenous infusion of Hartmann's solution and by the use of a lateral tilt of the operating table. Eleven patients had a blood pressure of less than 100 mm Hg, and in three of these, there was an adverse effect on the fetal heart trace.
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Int J Gynaecol Obstet · Jan 1977
Case ReportsAmniotic fluid embolism: a review of the literature with two case reports.
Amniotic fluid embolism (AFE) is a rare but dramatic obstetric complication. In this study, the pathogenesis of AFE and the disorders of coagulation and fibrinolysis and postmortem gross pathologic and histologic findings resulting from it are reviewed. The 2 case histories examined in this report exemplify different clinical courses of amniotic fluid embolism. ⋯ In the second case, generalized fibrinolysis dominated, and the woman survived. Finally, the authors wish to emphasize that the administration of fibrinogen is an incorrect approach to the management of this syndrome. A combination of Macrodex and heparin might be effective in preventing the formation of microthrombi, but increased fibrinolysis has to be treated by a sufficiently high dose of fibrinolytic inhibitors.