Zentralblatt für Gynäkologie
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Caesarean and vaginal deliveries of macrosomic infants weighing > or = 4500 g were studied, and pregnant women analysed by indication for caesarean section, presentation, parity and age. Both maternal and neonatal injuries occurred. Puerperal morbidity was noted in women delivered either by caesarean section or vaginally. ⋯ In conclusion, decision making on management options when delivering a macrosomic infant depends on fetal presentation and maternal age and parity. Vertex presenting macrosomic infants weighing > or = 4500 g should be delivered vaginally, but liberal judgement is suggested in resorting to caesarean section delivery. Abnormal presentation, as well as malpresentations in primiparous women, are an absolute indication for caesarean section, whereas malpresentations in multiparous women are a relative (underlying) indication for caesarean section.
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In a previous study 198 patients with histologically confirmed endometriosis underwent a "three-step" therapy, where surgical removal of endometriosis implants was followed by a 6 months treatment with 3.75 mg leuprorelinacetate depot as monthly subcutaneous injections and a second look laparoscopy with removal of residuals. In the following report long-term follow-up data generated in 112 of the above 198 patients on the post-treatment effect in respect to symptoms and pregnancy outcome in infertility are reported. For this purpose a special questionnaire was used. ⋯ Regain of quality of life and improvement of subjective conditions were reported in 54.9 % (28/51) and 52.9 % (27/51) respectively. The study results suggest that although the physiological effects of leuprorelin acetate treatment as suppression of ovarian function is rapidly reversible, the therapeutic effects linger, as evidenced by ongoing reduction of symptoms from baseline, leaving many patients asymptomatic or much improved longer than 1 year after treatment has ended. Besides long term relief and/or sustained reduction in symptom severity, the high pregnancy rate in infertility, as well as regain of quality of life and well being favour this therapeutic approach in endometriosis.
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Reduction mammaplasties can be performed--if contraindications are respected--as oncoplastic operations. They have the advantage that the lump has clear margins and is surrounded by a thick layer of healthy tissue. ⋯ The axillary cavity must be cleared and the oncoplastic (reconstructed) breast be irradiated with 50 Gy. The mastopexia (breastlifting) is less apt to be used as an oncoplastic operation, as the removed tissue is rather skin and subcutaneous fatty tissue than the breast gland itself.