Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Vascular laparoscopic injuries are rare (0.2/1000), however, they are associated with 6-13% morbidity and mortality. Commonest sites for catastrophic haemorrhage are the right iliac vessels, inferior vena cava and less commonly the abdominal aorta. The injuries commonly occur at entry using a Veress needle or insertion of trocars. ⋯ Major vascular injury is a rare but a potentially fatal complication. We propose a skills and drills approach to improve outcomes. We also propose a practical algorithms for the management of haemorrhage in the acute situation.
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Headache is one of the most common symptoms following delivery and the underlying cause may be benign or life threatening. Identification of the cause of headache in the postpartum period can be challenging and relies on a comprehensive history and thorough examination, with particular focus on the presence or absence of neurological signs, which may suggest a more serious diagnosis (Nelson-Piercy 2010 ). However, through clinical experience and research, we have noted that post-partum headache is significantly under-recognised and treated (Goldszmidt et al. 2005 ). ⋯ Research has shown that many postpartum headaches go undiagnosed and as a result are poorly treated, often returning following discharge from secondary care (Nelson-Piercy 2010 ). The hope is that the introduction of this adjuvant will allow clinicians to identify the cause of postpartum headaches earlier and will allow life threatening diagnoses to be quickly excluded.
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We aimed to determine the prevalence of Vitamin D deficiency among pregnant women and their newborns in order to make recommendations for Vitamin D supplementation, if necessary. It was a cross-sectional study carried out over a period of 12 months. Information such as use of Vitamin D supplements, number of daytime hours spent outdoors and dressing style was obtained from 166 pregnant women in Lagos, Nigeria; maternal and cord blood 25(OH)D concentration was determined using ELISA. ⋯ What the results of this study add? The results of this study adds that there may be some factors preventing adequate delivery of Vitamin D from the maternal circulation to the foetal circulation, because despite a low prevalence of Vitamin D deficiency in the mothers, their neonates had a high deficiency rate. What the implications are of these findings for clinical practice and/or further research? The implications of these findings are; further research is warranted in order to find what could be causing a reduced delivery of Vitamin D from the mothers to their foetuses, so as to prevent it if possible. Second, these findings suggest that our pregnant women should still receive a form of Vitamin D supplements, so as to raise their serum Vitamin D to a level which would guarantee optimal foetal concentration.