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 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Topical prostaglandins and intracervical tents at present comprise the most widely used methods for priming of the cervix before surgery. While tents and prostaglandins are comparable in terms of shortening the time interval between labor induction and delivery, tents do not initiate powerful myometrial contractions and thus are not associated with the complication of uterine hypertonus. In early abortion, tents are regarded as superior to prostaglandins, estrogen, and relaxin. In the midtrimester abortion, however, best results are achieved through the combined use of tents and prostaglandins. This approach facilitates a shorter abortion time, a lesser risk of sepsis, and use of a lower dose of prostaglandin. The effect of the particular type of tent selected--Clamicel, Dilapan, or Laminaria--is related to the initial state of the cervix, with the best results achieved in the soft patulous cervix of young pregnant women. Laminaria tents are declining in popularity as a result of their lengthy duration of action, unreliability, pain, or insertion and as the tent expands, and need for several insertions of multiple tents. The synthetic Dilapan tent does not share the disadvantages of inconsistency, long duration of action, and risk of sepsis, but tends to fragment and fracture so that the distal portion remains within the uterus. Lamicel, a polyvinyl alcohol sponge impregnated with magnesium sulfate, has a less impressive speed of action than Dilapan (3 hours and 2 hours, respectively), yet its softness makes it easy to withdraw without fragmentation or fracture. Lamicel has been used successfully in 1st-trimester abortion, before induction of labor or IUD insertion, for hysteroscopy and removal of lost IUDs, and in formal diagnostic curettage.
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PMID:Intracervical tents: usage and mode of action. 266 35

A case report of a ligamentary ectopic pregnancy that failed to respond to prostaglandin E2 for induced abortion for sepsis at 24 weeks is presented. The 27-year-old nullipara had normal ultrasound findings for gestational age up to 21 weeks gestation. She had consulted at 5 weeks for abdominal pain and bleeding, at 14 weeks again for abdominal pain, shoulder pain and vaginal bleeding, although both times the pain and bleeding resolved spontaneously. She was seen again at 16 and 21 weeks gestation, when ultrasound scans were normal for dates. At 24 weeks, she experienced vaginal discharge of blood and tissue, and was managed as premature rupture of membranes. She became septic 12 days later. She was treated with transcervical PGE2 and iv oxytocin without response for 3 days. Surgical evacuation was successful, but bleeding persisted. During laparotomy she had a large left broad ligament hematoma, a left ruptured uterus, and open left internal iliac artery and vein. These were repaired, and she received 40 units of blood, 8 platelets and 14 of plasma. Only after histology was the diagnosis of ligamentary pregnancy made. The lack of response to PG for abortion should raise suspicion of ectopic pregnancy, although preoperative diagnosis of ligamentary pregnancy is extremely rare.
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PMID:A rare gynecologic contraindication to the use of prostaglandins and oxytocin to induce abortion. A case report. 279 68

Incidence, risk factors and morphological features of the intravascular coagulation (IC) in 160 women who had died during pregnancy, after abortion and delivery were studied. IC was established in 118 (73.8%) of them. The main risk factors leading to IC were shock (59.3%), sepsis (28.8%), toxemia of pregnancy (incl. eclampsia) (25.4%), Caesarean section (19.5%), fetal death in utero (12.7%), amniotic fluid embolism (9.3%), and abruptio placentae (7.6%). Disseminated intravascular coagulation (DIC) was established in 66% of the cases, and local intravascular coagulation (univisceral localisation of microthrombi) in 28%. In the resting 6% of the cases there was consumptive coagulopathy without microthrombi. Lungs, pituitary gland, uterus, kidneys and adrenals were the most frequently affected organs. Necrosis in the parenchymal organs, hyaline membrane formation in the lungs and consumptive coagulopathy were particularly frequent in the cases with DIC. The leading causes of death were acute renal failure and ARDS. It was established that prolonged intensive care including artificial ventilation, massive blood transfusion, as well as surgical treatment, aggravate the course and morphological features of IC.
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PMID:Intravascular coagulation in relation to pregnancy and delivery. 281 60

Ruptured uterus continues to be a common obstetric hazard in underdeveloped countries, although it is rare in advanced countries. This paper analyzes the cases of uterine rupture brought to the University of Nigeria Teaching Hospital, Enugu over a 5-year period. The incidence of uterine rupture was 6.67/1000 deliveries; 40 of the 96 cases died, giving a mortality rate of 41.6%. The commonest cause is spontaneous rupture from obstructed labor in the multipara. There was not a single rupture in the primipara. Rupture following previous cesarean section scar is also common. A very significant factor in determing maternal survival in ruptured uterus is the operative skill of the surgeon; the maternal survival rate is greatly increased when specialist gynecologists, (consultants and senior registrars) as opposed to residents, handle the case. Higher maternal survival rates were also seen among patients who were receiving modern antenatal care. The most effective management involves, 1st, adequate resuscitation by replacing fluid and electrolyte loss and giving adequate blood replacement before laparotomy. Most Nigerian surgeons choose repair and sterilization as the quickest operation. However, the majority of cases of ruptured uterus are already infected and, in these cases, subtotal hysterectomy could in fact be the quickest operation. Furthermore, since most of the septic uterus is removed, the incidence of spreading septicemia is greatly reduced, and this could be a decisive factor in maternal survival.
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PMID:Factors influencing maternal survival in ruptured uterus. 286 42

This paper concerns an analysis of maternal death at the University of Ilorin Teaching Hospital over a 12 year period (1972-1983). There were 138,577 births and 624 deaths making a maternal mortality rate of 4.50/1000 births. Hemorrhage, ruptured uterus and obstructed labor were the major direct obstetric causes of death. The most important indirect causes were cerebrospinal meningitis, pulmonary infections and fulminating hepatitis. The main avoidable factors were ineffective and cumbersome blood transfusion services; poor management of the 3rd stage of labor; large number of unbooked patients and poor delivery room structure encouraging sepsis. Suggestions are made for a more integrated type of maternity service in this hospital, health education programs for the public and particularly the expectant woman, and availability of an effective blood bank service within the maternity hospital premises for prompt treatment of patients requiring emergency blood transfusion. The analysis underlines the great problem of maternal mortality in the developing world.
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PMID:Maternal mortality--a twelve-year survey at the University of Ilorin Teaching Hospital (U.I.T.H.) Ilorin, Nigeria. 288 43

Puerperal adynamic ileus includes acute mild and severe clinical manifestations. Acute severe puerperal adynamic ileus may constitute the clinical indication of a serious underlying disease, such as sepsis, rupture of uterus, intra-abdominal or retroperitoneal bleeding, ureteral pathology, intra-abdominal foreign body and internal diseases. Sometimes the diagnosis requires abdominal and chest X-ray, uterine exploration and intravenous pyelography. Surgical treatment requires proper previous general evaluation; and fluids, electrolytes and plasma should be provided.
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PMID:Puerperal adynamic ileus. 289 7

The maternal mortality rate in 10 hospitals scattered all over Anambra State, Nigeria, in a 5-year period were studied. The hospitals covered urban, semi-urban and rural areas. The maternal mortality rate varied from 1.8 to 13/1000 with a mean of 4.97/1000. This mean is 45 times the rate in England in 1978 and also compared less favorably with some other figures from third world sources. Attributable causes included obstetric hemorrhage (23%), ruptured uterus (27.6%), obstructed labor (13%), sepsis (12.1%), eclampsia (7.9%), anemia (2.9%), septic abortion (2.1%) and other causes. 16.7% of deaths were among 16-20 year olds; 14.6% among 21-25 year olds, 27.2% among 26-30 year olds; 18.8% among 31-35 year olds; and 22.6% among women older than 35. 87.5% of the women were unbooked. Of the 239 cases, 51 delivered vaginally, 162 by cesarean section, 12 by breech, 5 by TOP and 5 by destruction. Parity and age were important influences; at highest risk were primigravida and the grandmultipara, especially between para 4 and para 5. All the major causes of death are avoidable--either by obtaining prenatal and intrapartal care or by anticipating fetopelvic disproportion or abnormal lie. Lack of access to health facilities, especially in the rural areas, poor transportation, great distances to nearest health facility, are all implicated in obstructed labor deaths. Most cases of hemorrhage are avoidable through early diagnosis and recognition of high risk cases, prophylactic measures and availablity of blood transfusion and surgical delivery. Lack of antibiotics and non-adherence to normal aseptic precautions were also problems, especially in the 5 deaths from illegal abortions. Changes in the mortality rate can be made by accurate data collection, improved health facilities, improved socioeconomic status and basic education.
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PMID:Maternal mortality in Anambra State of Nigeria. 290 99

Depending on the extent of infection, abortions are usually classified as uncomplicated infected (feverish) abortions, in which only the fertilized egg and uterus are infected; complicated infected abortions, in which infection has spread beyond the uterus but remains localized in the pelvis minor; and septic abortions, in which infection has spread beyond the pelvis minor and become generalized. Disagreements are possible when defining uncomplicated and complicated abortions, since the term "infection within the uterus" can signify several inflammatory disorders varying in degree of severity and extent. The term "septic abortion" has also taken on a certain ambiguity and is even used to denote any abortion complicated by infection. The terms "septic abortion" and "septic condition" are often used synonymously. Infected abortions with clinical manifestations of septicemia are sometimes classified as "high-fever abortions" or "feverish abortions" with "septic abortion" syndrome. Recommendations for therapy are given: 1.) In uncomplicated infected abortions, the method of treatment is curettage of the uterus in the 1st hours after admission into the hospital. Medicinal preparation conducted for 2-6 hours before curettage reduces by nearly 1/3 the danger of inflammation spreading from the uterine cavity to the myometrium. 2.) When treating patients with complicated infected abortions, expectant-active treatment yields the best results. Curettage of the uterus is safe only after normalizing temperature, alleviating symptoms of toxic poisoning, and reducing local manifestations of infections. 3.) For patients with pronounced toxic poisoning related to resorptive-toxic fever or septicemia, clinical and laboratory observation and treatment must be conducted according to general procedures for acute sepsis therapy. Considering the special diathesis of these patients to septic shock, special measures to prevent shock should include increasing the dosage of antihistamines, medium doses of corticosteroids, and individually selected doses of heparin. This increases resistance to active intervention and the related entry of toxic substrate from the uterus into the blood stream. 4.) Treatment for an abortion complicated by generalized infection (septic abortion) should include radical surgical intervention on the primary septic source. The time and extent of surgical intervention are determined in each specific case individually, depending on the nature of the complication (sepsis, peritonitis, anaerobic infection) and condition of the patient. 5.) If indications develop for removal of the uterus, preference should be given to extirpation over amputation, since the harshest changes are usually localized in the isthmus of the uterus.
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PMID:[Debatable questions in the classification and therapy of the infectious complications of abortion]. 294 72

Basic principles of the public health system adopted in the Soviet Union are briefly discussed with special emphasis on the role of various risk factors in the prediction and prevention of maternal morbidity and mortality. The majority of risk factors for noninfectious diseases are associated with behavior and life style. Development of a healthy life style depends upon one's social activities, occupation, level of education, and ethnic factors. The network of free health care services is essential for a healthy life style, but other factors, such as type of nutrition, living conditions, and personal hygiene play an equally important role. The strategy of prevention of maternal morbidity and mortality is based on identification of risk factors for pregnancy, labor and the post partum period. Such risk factors as age, nationality, presence of extragenital diseases, and pregnancy complications should be ascertained during early pregnancy. Maternal mortality indices are correlated with the level of education: the higher the level the lower the mortality. The differences between mortality indices for urban and rural populations are associated with the differences in the life style, personal hygiene, and availability of health care facilities. Frequent pregnancies and pregnancies during an early and late reproductive period are considered a universal risk factor. Risk factors can be divided into prenatal and intranatal. Prenatal risk factors include a history of gynecological diseases, while intranatal factors include labor complications (hemorrhage, rupture of the uterus, sepsis, amniotic fluid embolism). Uncontrollable risk factors include age, population density, climate, or seasonal factors.
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PMID:[Methodology of studying and preventing maternal morbidity and mortality]. 337 32

The role of Bacteroides fragilis in the etiology of gynecological infections is illustrated by a case history of a 49-year old woman. The patient was seen for removal of a Super-Dana IUD inserted 10 years prior to the present admission. Gynecological examination indicated enlargement of the uterus and myomatous nodule in the anterior wall. The patient underwent typical total hysterectomy with bilateral adnexectomy. Histological examination of the surgical specimen showed uterine leiomyoma, proliferative endometrium, and a focus of subserous hemorrhage. Postoperatively, the patient was given the antibiotic tetraolean (100 mg, 4 times/day, for 5 days). On day 8 after the surgery, the patient rapidly developed clinical manifestations of sepsis. Vaginal examination showed mild infiltration of the parametrium and greenish-bluish putrid exudate. With provisional diagnosis of anaerobic-aerobic infection, the patient was given combined antibiotics. Bacteriological culturing of a specimen from vaginal exudate indicated the presence of Bacteroides fragilis. The patient received antibacterial therapy for 10 days, and was discharged in good condition. These findings illustrate the possibility of development of postoperative Bacteroides infection in patients with inserted IUD.
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PMID:[Bacteroides fragilis in anaerobic infection with bacteremia following total hysterectomy]. 344 14


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