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Query: UMLS:C0000737 (abdominal pain)
 31,184 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Information from 2 recent books on the most common abortion techniques is presented. Menstrual aspiration can be performed up to 14 days after a missed period. A flexible plastic cannula 4-5 mm in diameter is passed through the cervix to the uterus, and the contents are evacuated using a syringe. Little dilatation is required and the procedure is done under local anesthesia. Aspiration through the 12th week is usually done under general anesthesia using a cannula and mechanical aspiration. A curette is used to assure that the abortion is complete. Local anesthesia is used in some places. From 12-16 weeks a combination of scraping and aspiration is used with general anesthesia and sometimes forceps. The uterine cervix requires greater dilatation. After 16 weeks the amniotic fluid is removed and a solution of salt and water is injected into the woman under local anesthesia. Contractions begin about 24 hours later. Labor may also be induced by oxytocin or prostaglandins which result in 8-15 hours of labor. This method of abortion probably causes the greatest amount of anxiety in the patient. Uterine scraping is described in the 2nd book as a procedure in which the cervix is progressively dilated with metal instruments of different sizes until it is sufficiently dilated to permit passage of the curette. Laminaria tents were previously placed in the cervix 24 hours prior to the abortion to achieve slow and progressive dilatation. General anesthesia is required because cervical dilatation is painful. In uterine aspiration the contents of the uterus are removed using tubes called Karmen cannulas. It is sometimes possible to avoid cervical dilatation by using thin cannulas, in which case general anesthesia may be avoided. After the aspiration the uterus may be scraped to assure the complete removal of the uterine contents. Prostaglandins may be used to initiate uterine contractions leading to expulsion of the uterine contents during the 2nd trimester of pregnancy. The procedure may cause significant side effects. Other procedures consist of injecting various substances into the uterine cavity during the 2nd trimester of pregnancy. Hysterotomy involves surgical opening of the abdomen and is analogous to cesarean section. Possible complications of an induced abortion include uterine perforation, bleeding, infection, and in extreme cases maternal death through sepsis. Medical attention should be sought in cases of hemorrhage, abdominal pain, fever, or general malaise after an induced abortion.
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PMID:[Literary but technical abortion]. 655 11

Suction termination of pregnancy was performed in 276 patients as an out-patient procedure under general anaesthesia. Ergometrine, oxytocin, or sterile water were given with the induction of anaesthesia. There was no significant difference in blood loss in the three treatment groups, although blood loss in termination of pregnancy performed after eight weeks was increased in all three groups. Nausea, vomiting and abdominal pain occurred significantly more often after ergometrine compared to oxytocin or water.
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PMID:Blood loss and side effects in day case abortion. 729 2

The purpose of the present study was to measure plasma concentrations of oxytocin, cortisol and prolactin in children with recurrent abdominal pain of non-organic origin (RAP). Forty children with RAP and 34 controls, matched for age and sex, participated in the study. A blood sample was collected after an overnight fast in association with clinical examinations. Oxytocin, cortisol and prolactin levels were determined by radioimmunoassay (RIA). Oxytocin and cortisol concentrations in the children with RAP were found to be significantly reduced compared with those of the controls (approximately 24 versus 63 pmol/l for oxytocin and 160 versus 300 nmol/l for cortisol, respectively). The low oxytocin and cortisol levels persisted at a second examination 3 months later. No significant differences in the prolactin levels were observed between RAP and controls.
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PMID:Depressed concentrations of oxytocin and cortisol in children with recurrent abdominal pain of non-organic origin. 784 8

Over the last decade, the role of visceral sensitivity has been largely recognized in the pathophysiology of functional digestive disorders, particularly in the irritable bowel syndrome. These studies have highlighted the role of afferent pathways arising from the gut as a possible target for new treatments intended to relieve pain or modify altered reflexes present in such patients. These pharmacological targets have been identified mainly by studies on animal models of visceral hyperalgesia of various origins including local inflammation. Locally, several mediators are of paramount importance for sensitization of nerve endings: 5-hydroxytryptamine, bradykinin, tachykinins, calcitonin gene-related peptide, and neurotrophins. Selective antagonists to various subtypes of their receptors are currently available and have been shown to be active in these animal models. Other substances, such as somatostatin, opiold peptides, cholecystokinin, oxytocin, and adenosine, modulate the transmission of nociceptive inputs from the gut to the brain and are of clinical interest. This article reviews the current understanding of these mediators. Although these agents seem to be promising tools for the treatment of visceral hyperalgesia and its consequences (abdominal pain and disturbed reflexes), their clinical efficacy remains to be shown. A better understanding of the nature and the location of the defect in the sensory pathways may permit the selection of subgroups of patients for treatment according to the pharmacological properties of these new therapeutic agents.
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PMID:Mediators and pharmacology of visceral sensitivity: from basic to clinical investigations. 913 53

The aim of the study was to assess the effect of intraumbilical administration of oxytocin in the management of retained placenta. This prospective double-blinded clinical study included 31 mothers with retained placenta. The women were divided into three groups: group 1 (n = 19) was given 20 IU syntocinon in 20 ml 0.9% NaCl saline intraumbilically into the vein (IUV); group 2 (n = 8) received 20 ml 0.9% NaCl saline; and group 3 (n = 4) received 0.2 mg ergometrine IUV in 20 ml 0.9% NaCl saline. Intraumbilical injection was used 30-45 min after delivery, and the distal cord segment was clamped to the umbilical vein.--In group 1, placental expulsion within 60 min of IUV oxytocin injection occurred in 13 (68.4%) women; in group 2, placental expulsion was recorded in one (12.5%) woman, whereas no placental expulsion occurred in group 3 women (p < 0.001). Complications in terms of major hemorrhage were not observed in group 1, whereas a hemorrhage of > 500 ml was recorded in one group 2 and 3 woman each. Febrility developed in one woman, and abdominal pain in two women from each group. Manual lysis of the placenta was performed in seven group 1, seven group 2, and all four group 3 women. IUV oxytocin injection provides a useful and inexpensive non-surgical, non-aggressive, cheap and pharmacological method which should be included in the treatment protocol for retained placenta before turning to the procedure of manual lysis of the placenta.
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PMID:Treatment of a retained placenta with intraumbilical oxytocin injection. 1153 3

Spontaneous uterine rupture is a life-threatening obstetrical emergency encountered infrequently in the Emergency Department. Emergency Physicians must consider this diagnosis when presented with a pregnant patient in shock with abdominal pain. We present the case of a multigravid woman who had a spontaneous uterine rupture after induction with oxytocin, followed by a discussion of uterine rupture with special emphasis on the unscarred uterus. After the delivery, the patient was treated with fundal pressure and oxytocin due to severe vaginal hemorrhage. Despite the lack of vaginal hemorrhage after 1 h, the condition of the patient worsened. Laparotomy and a hysterectomy were performed. A parametrial hematoma about 20 cm was detected. The patient died 30 min after the operation. The treatment for intrapartum uterine rupture includes fluid resuscitation and emergency laparotomy.
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PMID:Maternal death after uterine rupture in an unscarred uterus: a case report. 1838 4

Several cases in which uteruses have been preserved in women with placenta percreta have been reported. We herein report a 38-year-old woman with a history of previous cesarean section who was admitted with lower abdominal pain and vaginal bleeding at 31 weeks of gestation. An urgent exploratory laparotomy revealed active bleeding from the uterine rupture on the posterior uterine wall. A female infant weighing 1560 g, with Apgar scores of 1,1, and 3 at 1, 5, and 10 min, respectively, was delivered, and the placenta was removed. We performed bilateral uterine vessel occlusion, followed by wedge resection of the ruptured uterine wall with the aid of an intrauterine muscle injection of 20 IU oxytocin, a local injection of diluted vasopressin (1:60) into the myometrium around and into the rupture site, and an intramuscular injection of 0.2 mg methylergonovine, primary repair of the defect, and an additional 24-h postoperative oxytocin infusion (30 IU in 5% dextrose 500 mL) to preserve the uterus successfully. Although the overall blood loss was 3700 mL, no disseminated intravascular coagulopathy occurred after the patient had received adequate blood transfusion. The postoperative pathological diagnosis was placenta percreta with uterine rupture. The patient and her baby were discharged uneventfully. In some cases of spontaneous uterine rupture secondary to placenta percreta, we can preserve the uterus by performing bilateral uterine vessel occlusion and wedge resection of the ruptured uterine wall.
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PMID:Uterine preservation in a woman with spontaneous uterine rupture secondary to placenta percreta on the posterior wall: a case report. 1933 2

Laparoscopic resection of deep infiltrating endometriosis (DIE) has been reported to be an effective method for reduction of endometriosis-associated pain. As its complications, bowel perforation, urinary tract injury and neurogenic bladder are well known; however, uterine vein rupture during pregnancy has not been reported previously. We encountered a case of hemoperitoneum resulting from uterine vein rupture at a delivery as a delayed consequence of laparoscopic resection of DIE. A 31-year-old, para 2 woman underwent laparoscopic resection of lateral pelvic peritoneum, uterosacral ligaments, and bilateral endometriomas, exposing uterine vessels, which we covered with fibrin glue. Endometriosis-associated pain disappeared, and then the patient conceived 4 months later. The course of pregnancy and induction of labor with controlled oxytocin infusion was uneventful, and the patient delivered a female baby without asphyxia. Immediately after delivery, low abdominal pain with hypotension occurred despite absence of abnormal vaginal bleeding. Ultrasonography and the blood hemoglobin value suggested hemorrhagic shock owing to hemoperitoneum; therefore emergency exploratory laparotomy was performed. Active bleeding was found at the right uterine vein, which was then sutured for hemostasis. The patient received a blood transfusion and recovered without any problems. The bleeding lesion was located at the vein on which the peritoneum had been removed at the first laparoscopy, which suggested that the operation for DIE included a risk of uterine vessel rupture during pregnancy.
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PMID:Uterine vein rupture at delivery as a delayed consequence of laparoscopic surgery for endometriosis: a case report. 1957 34

Postpartum haemorrhage is the leading cause of maternal mortality worldwide: 67-80% of cases are caused by uterine atony. Preventive measures include prophylactic drug use to aid uterine contraction after delivery, thus avoiding severe blood loss and reducing maternal morbidity and mortality. Carbetocin is a synthetic analogue of oxytocin with a half-life approximately 4-10 times longer than that reported for oxytocin. It combines the safety and tolerability profile of oxytocin with the sustained uterotonic activity of injectable ergot alkaloids. Furthermore, carbetocin can be administered as a single dose injection either intravenously or intramuscularly rather than as an infusion over several hours as is the case with oxytocin. Carbetocin is currently indicated for prevention of uterine atony after delivery by caesarean section in spinal or epidural anaesthesia. Data from three randomised controlled trials in caesarean delivery and a meta-analysis indicate that carbetocin significantly reduces the need for additional uterotonic agents or uterine massage to prevent excessive bleeding compared with placebo or oxytocin. The risk of headache, tremor, hypotension, flushing, nausea, abdominal pain, pruritus and feeling of warmth was similar in women who received carbetocin or oxytocin. The findings from two more recent double-blind randomised trials and one retrospective study suggest that carbetocin may also represent a good alternative to conventional uterotonic agents for prevention of postpartum haemorrhage after vaginal deliveries. A reduced need for additional uterotonics was observed with carbetocin vs. oxytocin in high-risk women and carbetocin was at least as effective as syntometrine in low-risk women. In these studies of vaginal deliveries, carbetocin was associated with a low incidence of adverse effects and demonstrated a better tolerability profile than syntometrine. Carbetocin had a long duration of action compared with intravenous oxytocin alone and a better cardiovascular side effect profile compared with syntometrine. In addition to being an effective treatment for the prevention of postpartum haemorrhage following caesarean delivery, carbetocin may also become the drug of choice for postpartum haemorrhage prevention after vaginal delivery in high-risk women and those who suffer from hypertensive disorders in pregnancy. Preeclampsia is still a contraindication to the administration of carbetocin in the EU, and further studies would be required to assess the cardiovascular effects of carbetocin before it can be advocated for routine use in preeclamptic patients. Further research is required to assess whether prophylactic carbetocin is superior to conventional uterotonic agents following vaginal delivery in low-risk women.
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PMID:Prevention of postpartum haemorrhage with the oxytocin analogue carbetocin. 1961 58

Uterine rupture during near-term pregnancy is a life-threatening condition. A 31-year-old pregnant woman with a breech presentation at the gestation age of 35(+2) weeks had complained of a dull abdominal pain for days. She was treated 2 years ago with bilateral uterine artery ligation and hysterotomy for removal of the retained placenta. An aggravation of abdominal pain occurred suddenly 4 h after hospitalization. The cardiotocogram showed a fetal heart beat with loss of variability, but increasing deceleration. An urgent cesarean section was performed because of suspected placenta abruption. After successful delivery of the fetus, a protruding placental tissue was found on the fundal uterine wall. We performed wedge resection of the ruptured uterine wall with the aid of an intrauterine muscle injection of 20 IU oxytocin, a local injection of diluted vasopressin (1:60) into the myometrium around and into the rupture site, an intramuscular injection of 0.2 mg methylergonovine, and primary repair of the defect, but in vain. Cesarean hysterectomy was used to control the intractable bleeding. The accumulated blood loss was more than 10,000 mL. The final pathology confirmed placenta percreta with uterine rupture. Luckily, both mother and fetus recovered well and were discharged 7 days later. We concluded that women with retained placenta and/or postpartum hemorrhage managed by previous hysterotomy and uterine artery ligation still need careful prenatal care, since the possibility of re-occurrence of the placenta percreta is easily overlooked and may result in a further life-threatening situation, such as the uterine rupture in this case.
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PMID:Uterine rupture secondary to placenta percreta in a near-term pregnant woman with a history of hysterotomy. 2153 13


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