Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Bilateral iliac artery ligation is an effective second-line procedure to control massive obstetric and gynaecological haemorrhage, it is life-saving in certain cases and has the advantage that it preserves fertility, which is particularly important in young women of low parity. Bilateral ligation of internal iliac arteries is a life-saving procedure in cases of massive obstetric haemorrhage. It has the advantage of preserving fertility compared with the commonly performed emergency obstetric hysterectomy. ⋯ We report here a case series of 11 women who had bilateral internal iliac artery ligation for severe pelvic haemorrhage in a period of 10 years in our department. Ten of them were obstetric cases and one was a case of haemorrhage following vaginal hysterectomy. The outcome was favourable in 10 out of the 11 cases and there was only one case of massive postpartum haemorrhage where the procedure failed and required an emergency hysterectomy.
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The aim was to evaluate the effect of caesarean delivery on the neonatal outcome after labour with fetal distress and/or meconium staining (MS). We audited 199 caesarean sections performed for non-reassuring fetal condition (NRFC) and/or MS in a rural regional hospital. The 1 and 5 min Apgar scores were compared with those of 33 vaginal births after labour with MS. ⋯ In the caesarean section group for NRFC, there were two fresh stillbirths and one early neonatal death, a perinatal mortality of 15.1/1,000 births. The 5 min Apgar score was not statistically significantly affected by the mode of delivery. Caesarean delivery does not improve the neonatal outcome when the amniotic fluid is meconium stained.
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A survey of 231 clinical directors in obstetrics and gynaecology in the British isles in 2005 asking about attitudes and practice relating to Caesarean Section (CS) had a 68.3% response rate. This paper reports on consultants' practice. Since our previous survey done in 1990 relating to births in 1989 the use of epidural anaesthesia had increased and the vast majority of caesarean sections were done under epidural or spinal aneasthesia and the majority of consultants allowed the partner to be present at the birth compared with 55% in 1989. ⋯ The proportion of women monitored routinely in labour had dropped from 45% to 11% although half still had an admission strip performed despite the 2001 guidelines. Few had read, the FIGO Ethics committee recommendations about non-medically indicated CS and it is suggested that the RCOG should bring such information to the attention of members through O&G news. A leaflet explaining the possible risks of CS and the long term implications should be produced by the RCOG alone or in conjunction with the Dept of Health so that women are better informed about these.