BJOG : an international journal of obstetrics and gynaecology
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Randomized Controlled Trial Multicenter Study
The impact of mode of anaesthesia on postoperative recovery from fast-track abdominal hysterectomy: a randomised clinical trial.
to determine whether the duration of hospital stay after abdominal hysterectomy in a fast-track setting differed between women operated under general anaesthesia or in spinal anaesthesia with intrathecal morphine. ⋯ in a fast-track model the duration of hospitalisation after abdominal hysterectomy was < 50 hours, independent of the mode of anaesthesia. Spinal anaesthesia reduced the need for postoperative morphine compared with general anaesthesia. In order to improve patient recovery after gynaecological surgery further studies based on fast-track programmes are needed.
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Although the transversus abdominis plane (TAP) block has an established role in providing postoperative analgesia following caesarean section, the technique is not widely used by obstetric anaesthetists. The conventional TAP block is associated with significant technical difficulties and risk of peritoneal, hollow viscus and organ perforation. We report a much simpler technique in which the obstetric surgeon, during open surgery, is able to introduce the TAP block via an intra-abdominal approach, which is technically easier and also obviates the risks associated with the conventional TAP procedure. We believe our technique may be easier, safer and equally effective.
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Multicenter Study Comparative Study
Critical illness with AH1N1v influenza in pregnancy: a comparison of two population-based cohorts.
To compare admissions to intensive care units (ICUs) with confirmed AH1N1v influenza in pregnancy in Australia, New Zealand and the UK. ⋯ The difference in admission risk may reflect a second phase effect from successful clinical and public health interventions, as well as differences in population characteristics between the countries. The overall severity of the AH1N1v influenza infection in pregnancy is evident, and emphasises the importance of an ongoing immunisation programme in pregnant women in both northern and southern hemispheres.
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Reliable data from South Africa emanating from WHO recommendations for the Safe Motherhood programme underscores HIV/AIDS as the most common cause of maternal deaths. The strengthening of HIV services for pregnant women especially in countries with a high burden of HIV infection will reduce HIV-related and un-related maternal mortality rates. High-quality and complete data on maternal deaths is a critical foundation for reliably monitoring temporal trends in maternal deaths, and causes thereof, but needs substantial strengthening in many resource-constrained settings. ⋯ A review of published data on maternal deaths and its association with HIV shows that reliable data come from the Confidential Enquiries into Maternal Deaths from South Africa, population-based surveys in sentinel populations, and facility-based data. Despite an increase in knowledge of the HIV status of pregnant women and the initiation of antiretroviral treatment, reversals in trends towards increased maternal deaths are not being observed. The strengthening of HIV services provides an opportunity to alter HIV epidemic trajectories and reduce maternal deaths.