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Query: UMLS:C0344307 (analgesia)
 28,200 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obstetric analgesia was accomplished by segmental continuous blockade in 225 women. The technique involved automatic pump infusion of 0.25 per cent bupivacaine solution into the epidural space at a rate of 5 ml per hour after initial doses of 2 and 5 ml bupivacaine. If the analgesia was insufficient one or two single injections of 5 ml of bupivacaine were added. Statistical evaluation of the results could be carried out for 218 women, 158 of whom were nulliparae and 60 multiparae. Fully satisfactory analgesia was achieved in 96 per cent of the nulliparae and 88 per cent of the multiparae in the first stage of labor. In the second stage of labor 46 per cent of the mothers were given pudendal blockade to maintain statisfactory analgesia. The positioning of the patient in the first stage of labor from supine to semirecumbent was of importance to spread the analgesic agent caudally, to the sacral nerve roots, and to control the pain due to stretching of the vagina and perineum. In the total material 17 per cent of the neonates were delivered by vacuum extraction. When the infusion into the epidural space was started in early labor, the incidence of vacuum extraction was 9 per cent, as compared with 38 per cent when it was started at 6 cm cervical dilatation or later (p less than 0.01). 9.8 per cent of the neonates were delivered by cesarean section. Fetal head malposition occurred in 8.7 per cent. A drop in blood pressure was noted in 7 per cent of the women. The condition of the newborn was unaffected by the analgesia. The mini-infusion system minimized the risk for infection. The danger in case of accidental intravascular injection was reduced, due to slowly administered bupivacaine. At the maternity department this technique has created a positive attitude towards epidural blockade, as midwives and doctors have found it safe and easy.
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PMID:Continuous mini-infusion of bupivacaine into the epidural space during labor. Part III: A clinical study of 225 patients. 28 10

The bladder of a 750-kg Clydesdale mare had everted through the urethra into the vagina immediately after parturition. The bladder was reinverted into the peritoneal cavity by an attending veterinarian, but 4 days later, the bladder was everted again in the vagina. The mare was able to void urine through both ureters, which could be seen in the mucosal surface of the bladder. The everted bladder had become edematous and could not be reinverted through the urethra. A considerable portion of the fundus was necrotic. The mare was administered xylazine epidurally to induce perineal analgesia, and the necrotic portion of the bladder was resected and healthy bladder tissue was opposed with a double layer of simple continuous sutures. The urethral sphincter was longitudinally incised through the vaginal mucosa to allow reinversion of the bladder through the urethra. A purse-string suture inserted in the urethral opening decreased the urethral diameter and prevented recurrence of the condition. An inflated Foley catheter was maintained in the bladder for 5 days. The mare recovered normal urination after the catheter was removed.
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PMID:Postpartum partial cystectomy through the vagina in a mare with everted partially necrotic bladder. 160 17

In the period from April 1987 to April 1990, 230 patients with pathological changes of the vulva, vagina and cervix uteri were treated with the CO2-laser. The diagnosis and pretreatment stages of the diseases were confirmed by the cytodiagnostic, colposcopic and histopathological results of the biophysics. In most cases, DNA-hybridization of human papilloma viruses confirmed their virus etiology. Twenty patients had peak condyloma of the vulva and vagina, 34 had benign cervical diseases, 65 were at the premalignant and 111 in the first stages of malignant cervical disease. Vaporizations, conical or cylindrical excisions were performed depending on the nature of disease and its localisation. The average age of operated patients was 30.6 years and the average parity 0.69. Operations were performed using analgesia and in rare cases total anesthesia. After the excision treatment, the tissue was checked histo-pathologically according to the principle of series. The complications were very rare. After operation, postoperative control was performed after 3.9 and 15 months, and later once a year. The results have shown that one treatment was sufficient in 80% of patients for curing vulvar and vaginal disease and 20% patients needed repeat because of the condyloma that relapsed. After the first treatment, benign and premalignant cervical diseases were cured in 100% of cases. In 95.4% operated patients at the first stages of cervical malignant diseases, the excisional treatment was final and in 4.6% needed an additional radical therapy because of a higher stage of lesion found by the conular histo-pathological analysis. There were no relapses relating to the cervix.
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PMID:[Use of the CO2 laser in the treatment of pathologic changes in the vulva, vagina and uterine cervix]. 209 98

The authors described the pregnancy and delivery of a woman with unstable angina pectoris (ECG data for ischemic disease of the heart). Delivery occurred through the vagina without complications for the mother and fetus. The literary references treat the question about course of pregnancy, way of delivery and analgesia in women with myocardial infarction during pregnancy.
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PMID:[Pregnancy and myocardial infarct]. 225 41

The use of prostaglandin analogues such as gemeprost has greatly improved the abortion rate in 2nd-trimester pregnancy; nonetheless, about 20% of women fail to abort after 24 hours of treatment with this method. RU-486, sensitizes the pregnant uterus to exogenous prostaglandins and has been shown in preliminary, uncontrolled studies to reduce the interval between extra-amniotic prostaglandin (PG) E2 instillation and expulsion as well as to reduce the amount of PGE2 required. The effect of pretreatment with RU-486 on prostaglandin- induced abortion was further evaluated in a double-blind, randomized study of 100 women in the 2nd trimester of pregnancy (12-18 weeks gestation). Study participants received 3 tablets of either a placebo or 200 mg of RU-486. 36 hours later, a 1 mg gemeprost pessary was inserted into the vagina and this treatment was repeated every 3 hours until either abortion occurred or 5 pessaries had been administered. The median interval to abortion after pessary insertion was significantly lower in the RU-485 pretreatment group (6.8 hours) than in the placebo group (15.8 hours). Moreover, women who received RU-486 required significantly fewer gemeprost pessaries (median of 3) than controls (median of 5); the former women also required significantly less analgesia. 94% of women in the RU-486 group compared to 80% of controls aborted during the 1st 24 hours after treatment. It is concluded that RU-486 pretreatment in gemeprost-induced 2nd-trimester abortion represents a major improvement in terms of safety and effectiveness.
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PMID:Pretreatment with mifepristone (RU 486) reduces interval between prostaglandin administration and expulsion in second trimester abortion. 240 84

Commonly used suture materials and techniques for perineal repair following vaginal delivery were compared in a randomized controlled trial involving 1574 women. Three comparisons were made using a modified factorial design. In the comparison of teflon-coated polyglycolic acid (Dexon plus) with chromic catgut for repair of the vagina and deep perineal tissues there was no clear difference other than less short-term analgesia being required in association with polyglycolic acid. Outcome was also similar after skin repair with either polyglycolic acid or chromic catgut or silk, although silk repair required more packets of material and was associated with delay in resuming sexual intercourse; polyglycolic acid was more likely to need removal than chromic catgut but it appeared to reduce the need for resuturing. There was no clear difference between continuous subcuticular and interrupted transcutaneous sutures for repair of perineal skin.
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PMID:The Southmead perineal suture study. A randomized comparison of suture materials and suturing techniques for repair of perineal trauma. 255 5

In a clinical trial, a physician treated 78 women having an abortion with either a Lamicel tent or a 1 mg gemeprost (Cervagem) pessary 3-4 hours before surgery. Researchers matched the women to age, parity, gestational age, and previous uterocervical surgery. The physician or the assistant chose the specific treatment in strict numerical order from randomly ordered sealed envelopes. Prior to surgery, an assistant used a speculum to empty the vagina of all traces of the Lamicel tent or the gemeprost pessary. Therefore each surgeon remained "blind" to the treatment used to dilate the cervix. Even though there was no significant difference in the blood and fluid loss between the 2 groups (t = .67; p = .5), both surgeons did observe a greater resistance of cervices to dilate after Lamicel than after gemeprost (p .001). Patients who received gemeprost experienced more adverse effects preoperatively, especially abdominal pain (74%) and bleeding (18%), than did those who were treated with Lamicel (50%. and 7.5% respectively). Despite a higher percentage of women experiencing side effects with gemeprost, there was not a corresponding increased need to administer analgesia. Postoperative side effects were similar in both the gemeprost and Lamicel groups. Additionally, no significant differences existed between the 2 groups in regards to postoperative analgesic requirements or preoperative and postoperative temperature, pulse rate, and blood pressure. Notwithstanding the side effects of gemeprost, it was more effective in dilating the cervix, easier to insert, and less uncomfortable than Lamicel.
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PMID:A comparison of gemeprost (Cervagem) pessaries and Lamicel tents for cervical preparation for abortion by dilatation and suction. 305 5

To avoid some of the discomfort associated with suction curettage with intravenous analgesia and paracervical block, a 2-state ambulatory modification of the Luenbach paste method of abortion was developed. This combines cervical softening by the transcervical instillation of 10-20 cc of mild anticeptic paste. The vagina is packed with sterile gauze. 24 hours later, when the patient returns, the aspiration is carried out. Usually neither local anesthetic or analgesia are required for dilatation. The negative pressure required is only 55-60 cm instead of 70 cm. The advantages of this technique include elimination of para-cervical block, built in antisepsis, less chance of uterine perforation, easier evacuation, and fewer resulting incompetant cervices. A brief discussion of the legal status of abortion in Michigan is presented.
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PMID:Update on abortion in Michigan. 463 44

The incidence of parturition difficulties from 239 sheep and 21 does from the last seven lambing periods was recorded at a clinic for obstetrics. Without exception the does were housed under extensive conditions by hobby-breeders. The sheep also originated predominantly from hobby-breeders and in a smaller amount from professional breeders, both practising extensive housing. The incidence of manual deliveries (m.d.) in both species was lower (39.3% in sheep; 42.8% in does) than that of caesarean sections (c.s; 57.3% in sheep; 47.7% in does). In a small amount the obstetrics were solved via fetotomy. The practical proceedings concerning the different methods of therapies including analgesia, surgical approaches and postoperative treatments are described. In sheep ringwomb was the dominating reason for dystocia for m.d. (43.5%) as well as for c.s. (73.7%), followed by obstetrics due to fetal abnormal presentation and/or position or posture (25.2% m.d.; 1.1% c.s.), secondary oversized fetuses due to postmortal emphysema and edema (19.1% m.d.; 10.7% c.s.), followed by primary relative or absolute oversized fetuses (1.0% m.d.; 4.8% c.s.) and simultaneously presentation of multiple fetuses (4.2% m.d.). Other causes of dystocia remained scarce (i.e. uterine torsion, hydrallantois, abdominal or perineal hernia). There rested an amount of sheep (7.1%) with preterm s.c. because of continuous pressure and pain symptoms followed by infections or injuries of the prolapsed vagina and/or rectum, pregnancy toxemia and other reasons. The main indication for fetotomy in sheep were fetuses with postmortal edema and emphysema (80.0%), deformity of the kids (20.0%) respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Birth difficulties in sheep and goats--evaluation of patient outcome from seven lambing periods in an obstetrical clinic]. 772 May 47

Hundred cases of preterm labour (before 36 weeks) with cervix 4 cm or less dilated and preterm prelabour rupture of membranes (excluding cases of uterine overdistension, maternal medical disorders and fetal congenital abnormalities) were treated with bed rest and sedation. Labour set in within 2-6 days with high fetal morbidity and mortality. Another fifty similar patients were given in addition to rest in hospital for 48 hours, 1000 ml of 5% dextrose in six hours, intravenous antibiotics (after sending off cultures from the vagina per speculum), corticosteroids and a single dose of analgesia/sedation injection. In 85% painful contractions ceased and membranes stopped leaking until near term. In 10% painful contractions ceased, but leakage continued for 2-7 weeks, and the gain in intrauterine life led to 100% neonatal survival with short hospital stay in the neonates born after 31 weeks. Only 5% failed to respond to treatment and after delivery these premature neonates developed pneumonia and septicaemia from the same organisms that were colonizing their maternal genital tract and had entered the fetus via the infected amniotic fluid. It is recommended that all patients in preterm labour or preterm prelabour rupture of membranes (excluding overdistension) be given besides bed rest and sedation, corticosteroids and antibiotics intravenously for 48 hours and then orally for eight more days. Tocolytics are not recommended. This regime saves babies.
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PMID:Active management of preterm labour and preterm prelabour rupture of membranes. 783 Mar 4


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