Nederlands tijdschrift voor geneeskunde
-
A committee of the Scientific Council of the National Organization for Quality Assurance in Hospitals has published a report on the diagnosis and management of children with meningitis. Agreement was achieved on the diagnostic investigations that should precede antibiotic treatment, and on the prognosis and follow-up of children recovered from meningitis. ⋯ Furthermore there was no consensus on the prophylactic administration of rifampicin to family members of patients with meningitis caused by Neisseria meningitidis or Haemophilus influenzae. The arguments pro and contra are mentioned and considered.
-
Ned Tijdschr Geneeskd · Apr 1989
Comparative Study[Functional treatment of Colles fractures and the relation of anatomic recovery and function].
Functional treatment of Colles fractures is a recently developed approach to fracture injury. It aims to bring about faster recovery and a better functional end result by permitting early motion and function by means of a functional brace. Early motion and function, however, might jeopardize the anatomical result. ⋯ Minimally displaced Colles fractures (volar angle greater than or equal to 0 degrees) should be treated with a bandage after one week of plaster immobilisation. The relationship between the anatomical and functional end result is weak and probably depends on initial displacement and complications. To improve the functional result after a Colles fracture, prevention and better treatment of complications seem to be more important than improvement of the method of fracture treatment of the anatomical end result.
-
An analysis is presented of the outcome of labour in 462 women with a previous caesarean section, who delivered in the department of obstetrics of Leiden University Hospital in the period 1977-1986. Elective repeat section was performed in 26% of these women, while 83% of those accepted for a trial of labour had a vaginal delivery. In 196 women with a history of a previous caesarean section (1984-1986) a retrospective analysis was made of the influence of the indication for the previous caesarean section with respect of the outcome of labour in the following pregnancy. ⋯ Sixty-five percent of women who had had a prior caesarean section because of cephalopelvic disproportion or failure to progress delivered by the vaginal route after a trial of labour. Foetal weight estimation by ultrasound could not predict the outcome of a trial of labour. It is concluded that a trial of labour after a previous caesarean section, even when the operation was performed because of cephalopelvic disproportion or failure to progress, is safe and rational.
-
Of 249 women whose last pregnancy was terminated by a caesarean section, 57 (22.9%) were delivered again by a primary caesarean section. The other 192 (77.1%) were allowed to attempt vaginal birth. Of these, 151 (60.6%) were successful, and 41 (16.5%) underwent a repeat caesarean section. ⋯ In the secondary caesarean section group there were more children with a low one minute Apgar score than in the group delivered vaginally or by a primary caesarean section. It is concluded that there are sufficient arguments against routinely performing a repeat caesarean section after a previous one. The indication for the previous caesarean section can be an important aid in the selection of women to be allowed to try a vaginal delivery.