Obstetrics and gynecology
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Obstetrics and gynecology · Sep 2012
Review Meta Analysis Comparative StudySuprapubic compared with transurethral bladder catheterization for gynecologic surgery: a systematic review and meta-analysis.
Suprapubic catheterization is commonly used for postoperative bladder drainage after gynecologic procedures. However, recent studies have suggested an increased rate of complications compared with urethral catheterization. We undertook a systematic review and meta-analysis of randomized controlled trials comparing suprapubic catheterization and urethral catheterization in gynecologic populations. ⋯ Based on the best available evidence, no route for bladder drainage in gynecologic patients is clearly superior. The reduced rate of infective morbidity with suprapubic catheterization is offset by a higher rate of catheter-related complications and crucially does not translate into reduced hospital stay. As yet, there are insufficient data to determine which route is most appropriate for catheterization; therefore, cost and patient-specific factors should be paramount in the decision. Minimally invasive surgery may alter the requirement for prolonged postoperative catheterization.
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Obstetrics and gynecology · Sep 2012
Comparative StudyRisk factors for postoperative urinary retention after laparoscopic and robotic hysterectomy for benign indications.
To estimate the occurrence of postoperative urinary retention after traditional laparoscopic and robotic hysterectomy. ⋯ Transient urinary retention is relatively more common after robotic hysterectomy when compared with laparoscopic hysterectomy. We postulate that more aggressive bladder dissection performed with robot assistance may be associated with an increased risk of urinary retention.
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Pregnancies complicated by severe sepsis and septic shock are associated with increased rates of preterm labor, fetal infection, and preterm delivery. Sepsis onset in pregnancy can be insidious, and patients may appear deceptively well before rapidly deteriorating with the development of septic shock, multiple organ dysfunction syndrome, or death. The outcome and survivability in severe sepsis and septic shock in pregnancy are improved with early detection, prompt recognition of the source of infection, and targeted therapy. ⋯ The decision for delivery in the setting of antepartum severe sepsis or septic shock can be challenging but must be based on gestational age, maternal status, and fetal status. The natural inclination is to proceed with emergent delivery for a concerning fetal status, but it is imperative to stabilize the mother first, because in doing so the fetal status will likewise improve. Aggressive [corrected] treatment of sepsis can be expected to reduce the progression to severe sepsis and septic shock and prevention strategies can include preoperative skin preparations and prophylactic antibiotic therapy as well as appropriate immunizations.
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Obstetrics and gynecology · Sep 2012
Comparative StudyEffect of influenza vaccination in the first trimester of pregnancy.
To estimate the effect of first-trimester influenza vaccination on fetal and neonatal outcomes. ⋯ Influenza vaccination in the first trimester was not associated with an increase in major malformation rates and was associated with a decrease in the overall stillbirth rate. This information will aid in counseling women regarding the safety of influenza vaccination in the first trimester.