Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Haemorrhage is one of the leading global causes of maternal mortality. The Rüsch balloon has been used in the treatment of postpartum haemorrhage (PPH) after failure of medical management. It is often effective in tamponading uterine bleeding, thus providing an alternative to hysterectomy. ⋯ We include a review of the current literature on balloon tamponade for PPH, including analysis of six relevant case series. This demonstrates a variety of methods based on tamponade to terminate uterine haemorrhage. Our study highlights the benefit of balloon tamponade for massive PPH and the importance of its involvement in labour ward protocols.
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Randomized Controlled Trial
Does saline irrigation reduce the wound infection in caesarean delivery?
The aim of this prospective randomised study was to estimate the effect of saline wound irrigation before wound closure in the prevention of infection following caesarean delivery. Participants with indications for elective or emergency caesarean section were randomly allocated to two groups. A total of 260 women who underwent wound irrigation before wound closure and 260 did not. ⋯ There were also no significant differences between the groups in terms of factors known to influence wound infection. The incidence of wound infection was 7.3% for the control group and 6.5% for the saline group; however, the difference was not significant (relative risk: 0.88; 95% confidence interval: 0.45-1.74; p=0.86). In conclusion, saline wound irrigation before wound closure did not reduce the infection rate in patients undergoing caesarean delivery.
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Comparative Study
Anaesthesia preference, neuraxial vs general, and outcome after caesarean section.
We investigated parturients' preference for neuraxial vs general anaesthesia, while they have experienced both techniques in the past. A total of 102 parturients who underwent elective caesarean section under general or neuraxial anaesthesia at different times completed a questionnaire comparing the two techniques. ⋯ Neuraxial anaesthesia was associated with less pain assessed by the Verbal Analogue Scale (VAS) (54 ± 21 vs 72 ± 20 p < 0.001), fewer days of hospital stay (4 ± 0.5 vs 5 ± 1.5, p = 0.001) and higher satisfaction scores (77 ± 18 vs 52 ± 24, p = 0.001) vs general anaesthesia. Finally, 80% of the women would choose neuraxial anaesthesia for a future caesarean section.
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The incidence of morbidly adherent placenta is rising and is directly proportional to the rate of rise of caesarean deliveries. Despite improvement in antenatal diagnosis, by accuracy of ultrasound and MRI techniques, placenta accreta is still associated with a high maternal morbidity rate. Management of pregnancies with a morbidly adherent placenta is extremely challenging and is becoming an increasingly common problem for maternity units globally. ⋯ Traditionally, these cases were managed by caesarean hysterectomy. There has now been a shift towards conservative management of placenta accreta, involving uterine and placental conservation, with the aid of interventional radiology by means of insertion of occluding balloons into appropriate vessels. We describe three cases of morbidly adherent placentas, managed at our unit where meticulous preoperative planning, multidisciplinary approach and the key role of interventional radiology led to a safe outcome for both the mother and the baby.
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This study is a review of our experience of using the cell saver in obstetrics. The main aim was to determine its role in decreasing the need for homologous blood transfusion. A retrospective study of patients identified as being at high risk of massive obstetric haemorrhage at the time of caesarean section during the period between July 2005 and August 2008, was undertaken. ⋯ A total of 13 units of salvaged blood were transfused successfully, saving approximately GB£1,800. Cell salvage in our practice has not been very effective due to non-availability of trained staff in emergencies and unfamiliarity of techniques, leading to poor salvage via suction. Most of our blood loss is swabbed not suctioned and lack of salvaging blood from swabs is a contributory factor.