J Gynecol Obst Bio R
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J Gynecol Obst Bio R · Apr 2009
Review Case Reports[Abdominal migration of a levonorgestrel-releasing intrauterine device. Case report and review of the literature].
We report the case of a 27-year-old woman in amenorrhea after the installation of a levonorgestrel releasing intra-uterine device, 3 years previously. In front of pelvic continuing pains, paraclinic explorations diagnosed the DIU-LNG in intra-abdominal situation. An exploratory laparoscopy was realized and allowed its ablation. The authors discuss the systemic distribution of the levonorgestrel and the impact of the DIU-LNG in intra-abdominal situation by a review of the literature.
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The aim of the anaesthesia for instrumental delivery is to provide optimal operation conditions for the obstetrician, appropriate maternal comfort, altogether with safety for the mother and her foetus. The type and location for this intervention are chosen individually for each case according to the indication, the risk of caesarean section and the local specificities. ⋯ A spinal anaesthesia is a logical choice where an epidural in sot yet working. The pudendal block is a second line choice and the general anaesthesia remains as the last alternative in acute emergencies, in cases of failed regional anaesthesia or when the mother refuses any other anaesthesia despite proper information or proves unable to cooperate.
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Several interventions have been demonstrated, with high evidence levels (EL), to be associated with reduced instrumental deliveries and should therefore be undertaken during labor for increasing spontaneous vaginal deliveries. Using a partogram (EL1) and continuous support during labor and childbirth (EL1) lead to fewer operative vaginal deliveries. Systematic early amniotomy increases the frequency of fetal heart rate abnormalities (EL2) without decreasing the incidence of instrumental deliveries (EL1) and should thus be avoided. ⋯ This effect is reduced when low concentrations of local anesthetic are used in combination with fat-soluble morphinated agent (EL1). Finally, for nulliparous women with continuous epidural analgesia, unless irresistible urge to push or medical indication to shorten second stage of labor, delayed pushing is associated with reduced difficult instrumental deliveries (EL1). Fundal pressure maneuvers should be prohibited because of their inefficiency (EL2) and dangerousness (EL4).
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J Gynecol Obst Bio R · Dec 2008
[Transobturator subvesical mesh: Tolerance and mild-term results. A prospective study].
To evaluate midterm results, tolerance and efficiency of interposition of a transobturator subvesical mesh for the repair of cystoceles. ⋯ Transobturator mesh is a safe and efficient method for anterior segment prolapse repair. This procedure is simple, mini-invasive, reproducible and efficient with low morbidity and good tolerance.
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J Gynecol Obst Bio R · Oct 2008
Review[Complications and monitoring of the latency period after a preterm premature rupture of the fetal membranes: literature review].
Preterm premature rupture of the membranes (PPROM) begins a high-risk period for both mother and fetus. This literature review updates the knowledge on latency-period complications and proposed monitoring strategies. Four latency-period complications are described: spontaneous onset of labor, infection (chorioamnionitis), abruptio placentae, and fetal, distress which can be linked to umbilical cord prolapse. ⋯ The prediction of infection seems to be essential; classical markers, such as blood count and reactive C protein are not very effective. New markers have been tested, with IL-6 appearing to be one of the best infection markers. Fetal pulmonary maturity can be evaluated with a rapid screening test and can yield arguments for the management strategy.