Acta obstetricia et gynecologica Scandinavica
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Acta Obstet Gynecol Scand · Jan 1975
Different methods of reconstruction after vulvectomies for cancer of the vulva.
Direct wound closure with or without flap-plasty after vulvectomy gives satisfactory cosmetic and functional results. Split thickness skin-grafts seem to be of limited value in the repair of the defects.
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Acta Obstet Gynecol Scand · Jan 1975
Continuous epidural anaesthesia with a low frequency of instrumental deliveries.
The results of 204 cases of regional analgesia by means of continuous epidural block during labour and delivery are reported. The frequency of instrummental intervention using forceps or the vacuum extractor is low, less than 15% for primi- and multi-gravidas combined, although pathological conditions were recognized prior to blockade in almost one-third of the parturients. Moreover, the frequency of emergency Caesarean section has dropped significantly since epidural anaesthesia was introduced into the clinic. ⋯ The amount of blood lost by mothers given epidural anaesthesia was, on average, 15% less than in a control group. It is concluded that the essential feature of our technique of administering continuous regional analgesia is a selective block of small pain fibres with the deep tactile sensations largely intact, and the motor pathways virtually unaffected. This has been achieved using small doses of bupivacaine 0.25% concentration and meticulous observation of the individual patient.
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Acta Obstet Gynecol Scand · Jan 1975
An improved method of epidural analgesia with reduced instrumental delivery rate.
A detailed study on a modified technique of epidural analgesia (EDA) for pain relief in obstetrics has been performed. The aim of the modifications was to reduce the number of instrumental deliveries and at the same time to make the delivery as smooth as possible for the baby. This was achieved by the use of an anaesthetic with a favourable ratio between neonatal and maternal plasma levels (Bupivacaine) in low concentration (0.25%). ⋯ The clinical status of the babies was found to be better after EDA than in control group, as judged from Apgar score. Furthermore, fetal bradycardia was significantly reduced with EDA. It is concluded that EDA, as used in this study, not only is a preferable way of achieving pain relif in the mother but also offers a means of facilitating the birth process for the infant, reducing the incidence of pre- and post-natal asphyxia.