Archives of gynecology and obstetrics
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Arch. Gynecol. Obstet. · Apr 2015
Randomized Controlled TrialEarly postoperative bladder training in patients submitted to radical hysterectomy: is it still necessary? A randomized trial.
To evaluate the role of bladder training during postoperative hospital stay in patients submitted to nerve-sparing radical hysterectomy, and to identify any clinical or surgical factor associated with postoperative bladder dysfunction. ⋯ Functional bladder disfunctions are the most common long-term complications following radical hysterectomy. Systematic postoperative bladder training following nerve-sparing radical hysterectomy does not influence the rate of urinary retention or re-admission for bladder catheterization.
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Arch. Gynecol. Obstet. · Apr 2015
Case ReportsImpact of 'fire drill' training and dedicated obstetric resuscitation code in improving fetomaternal outcome following cardiac arrest in a tertiary referral hospital setting in Singapore.
Cardiac arrest in pregnancy is a rare but catastrophic obstetric emergency, with a quoted incidence of 1:20,000 pregnancies. Speedy multidisciplinary interventions are crucial for good maternal and foetal outcomes. A perimortem caesarean section (PMCS) initiated within 4 min of onset of cardiac arrest to minimise the effect of aortocaval compression on cardiopulmonary resuscitation (CPR) has been recommended as a key intervention, which is likely to improve survival of both mother and foetus. ⋯ We propose that a focus on effective and good-quality CPR, utilising key interventions such as early airway control, left uterine displacement and a timely decision for a PMCS with multidisciplinary input is more likely to result in good maternal and foetal survival and neurological outcomes. We also discuss the role of 'fire drill' obstetric training for key staff and the use of a dedicated hospital-wide resuscitation code for managing collapse in obstetric patients in improving survival and outcomes. We present four cases of maternal cardiac arrest managed with PMCS in our hospital, highlighting the evolution in management and with improved outcomes following changes to our resuscitation guidelines, training and workflows.
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Arch. Gynecol. Obstet. · Apr 2015
Emergency peripartum hysterectomy in a tertiary teaching hospital: a 14-year review.
To determine incidence, risk factors, indications, outcomes, and complications of emergency peripartum hysterectomy (EPH) performed in a tertiary teaching hospital and to compare the results with literature data. ⋯ Abnormal placentation was the most common indication for EPH, requiring in most of the cases a total hysterectomy. Previous CS was a risk factor for abnormal placentation and in particular for pathological adherence of the placenta. EPH remains associated with a high incidence of morbidity and mortality.
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Arch. Gynecol. Obstet. · Mar 2015
Multicenter StudyAnesthetic management of prophylactic cervical cerclage: a retrospective multicenter cohort study.
Cervical incompetence complicates approximately 1 in 500 pregnancies and is the most common cause of second-trimester spontaneous abortion and preterm labor. No prospective or large retrospective studies have compared regional and general anesthesia for cervical cerclage. ⋯ Both regional and general anesthesia were safely used for the performance of cerclage. Patients after general anesthesia had a shorter recovery time but a higher demand for opioids and non-opioids analgesia.
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Arch. Gynecol. Obstet. · Mar 2015
Randomized Controlled TrialTopical anaesthetic patches for postoperative wound pain in laparoscopic gynaecological surgery: a prospective, blinded and randomised trial.
Aim of this prospective study was to investigate the effectiveness of eutectic mixture of local anaesthetic (EMLA) patches on every abdominal incision for pain relief after gynaecologic laparoscopic surgery. ⋯ Despite of a significant reduction of time for mobilisation transdermal anaesthetic patches after gynaecologic laparoscopic surgery did not lead to decreased postoperative pain scores.