Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
-
Randomized Controlled Trial
Randomised clinical trial of the influence of pulmonary recruitment manoeuvre on reducing shoulder pain after laparoscopy.
Shoulder pain after laparoscopy is common and its probable mechanism is residual CO(2) gas after surgery. The aim of this study was to examine the effect of pulmonary recruitment manoeuvre which means pulmonary inflation with positive pressure of 40 cm H(2)O to remove gas and reduction of shoulder pain after gynaecological laparoscopic surgery. A double-blind clinical trial on 146 patients for minor gynaecological laparoscopy was performed from May 2008 to February 2009. ⋯ Pain scores in the control and intervention group were 3.6 +/- 3.5 vs 1.28 +/- 1.7; 3.4 +/- 2.9 vs 1.19 +/- 1.7; 2.6 +/- 2.4 vs 0.89 +/- 1.3; 1.5 +/- 1.6 vs 0.46 +/- 0.7, at 4, 12, 24 and 48 h after operation, respectively (p < 0.001). The controls had greater usage of analgesics 1.12 +/- 5.67 compared with 0.95 + 0.31 in the cases. It was concluded that pulmonary recruitment manoeuvre seems to be a simple and safe way to reduce shoulder pain and analgesic use after laparoscopy.
-
The aim of this study was to assess the effectiveness of the different referral pathways to accessing abortion services. It was a retrospective observational study comparing abortion referral processes in two district hospitals. The results showed that 149 patients self-accessed the NHS abortion service in group A compared with group B of 365 formally referred patients. ⋯ However, 74% of patients in group A had their termination request met within 7 days of the initial appointment, compared with only 37% in group B (p = 0.0011). A total of 70% of terminations performed in group A were undertaken at less than 10 weeks' gestation, compared with only 31% in group B (p < 0.0001). It was concluded that the open referral pathway to accessing NHS abortion services, where available, appears to be effective in allowing more abortions to be undertaken at an early gestation.
-
The study was done to determine obstetricians' attitude to and factors predicting obstetricians' acceptance of caesarean delivery on maternal request in Nigeria. Nigerian obstetricians were asked to respond to case scenarios depicting caesarean delivery on maternal request without medical indications and the reasons for their responses. The case scenarios were designed from previously published reasons for caesarean delivery on maternal request from Nigeria. ⋯ A good proportion (48.8%) of Nigerian obstetricians had performed at least one caesarean on maternal request. Obstetricians' bio-professional characteristics do not influence their attitude to request caesarean delivery on maternal request. Some obstetricians expressed fear of legal consequences from caesarean delivery on maternal request.
-
This was a retrospective review of all cases of peripartum obstetric hysterectomy performed at the Istanbul Bakirkoy Women and Children's Teaching Hospital in the period between January 2001 and September 2008. We included any women who required emergency hysterectomy to control major postpartum haemorrhage after delivery. During the study period, there were 91 cases of peripartum hysterectomy. ⋯ The main indication for emergency hysterectomy was uterine atony in 52 cases (57.1%). The most independent risk factors for emergency hysterectomy were multiparity (odds ratios (OR) 17.3, 95% confidence interval (95% CI) 8.7-34.6); caesarean delivery in index delivery (OR 6.7, 95% CI 3.8-11.9) and caesarean section for placental abruption (OR 3.8, 95% CI 0.4-33.4). Our study suggests that multiparity, primary or repeat caesarean deliveries for placental abruption are independently associated risks for peripartum hysterectomy and uterine atony is the still most common indication for peripartum hysterectomy in Turkey.
-
Perimortem caesarean section (PCS) is a rare event often resulting in high mortality of mother and/or fetus. It represents a tragedy for the mother and the family and a crisis for the healthcare professionals managing such a case. This paper seeks to raise awareness of the pertinent issues surrounding PCS and challenges care providers to put in place procedures to deal with this catastrophic event. It also reviews the historical perspective of PCS, maternal physiology during cardiopulmonary resuscitation (CPR), prognostic factors for maternal and fetal wellbeing, techniques of PCS, survival for mother and baby and the medico legal aspects of PCS.