Caesarean myomectomy: new frontier in surgical practice.
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Blood Loss, Surgical↗
Biomedical subjects
A B Ande
Publications and source records attributed to A B Ande.
Two vaginal deliveries after a classical caesarean section--case reports.
It is standard practice to offer a parturient who has had a classical Caesarean section an elective repeat Caesarean section due to the fear of uterine rupture. The strong aversion of our women to operative delivery does not allow an appreciable number to avail themselves of hospital delivery even after Caesarean section. We report the case of a booked patient who had a classical Caesarean section but defaulted in two subsequent pregnancies to have vaginal deliveries in a private hospital. We therefore suggest a more liberal attitude to allowing attempt at vaginal delivery as an informed decision in well-equipped facilities capable of easy and prompt resort to appropriate intervention.
Adult↗
Myomectomy during cesarean section.
OBJECTIVES: To assess the intra- and post-operative complications of cesarean myomectomy. METHODS: The study design was descriptive, and the setting was the Department of Obstetrics and Gynaecology, University of Benin Teaching Hospital and two private consultant units, all in Benin City. The subjects were 25 pregnant women undergoing elective or emergency cesarean section at these units. The outcome measures were blood loss and need for blood transfusion, intra- and post-operative complications and duration of hospital stay. RESULTS: Eighty-four fibroids of various sizes (2-10 cm) were removed from the 25 women. The fibroids were on the anterior uterine wall with most (94.8%) being sub-serous or intramural, and only few (five) sub-mucous. The mean blood loss was 876+/-312 ml, range 400-1700 ml. Five patients (20%) had two units of whole blood transfusion. There was no case of severe hemorrhage necessitating hysterectomy. Eighteen patients (72%) had post-operative morbidities mainly of anemia [15 (60%); hematocrit 26+/-2.9%). The average duration of post-operative hospital stay was 7.4+/-2.2 days (range 3-12 days). Three (12%) patients have subsequently become pregnant, two (66.7%) of whom had normal vaginal deliveries, while the third had a repeat elective cesarean section. CONCLUSIONS: With adequate experience and the use of high dose oxytocin infusion (intra- and post-operatively), myomectomy at cesarean section is not as hazardous as many now believe.
Adult↗
Anaesthesia related complications following caesarean delivery necessitating intensive care unit admissions in a tertiary centre.
To determine the anaesthesia-related complications after caesarean section in a tertiary hospital, the hospital records of parturients admitted to the Intensive Care Unit (ICU) after caesarean section were studied. In a ten-year period, 2,686 women were delivered by caesarean section at the University of Benin Teaching Hospital, Benin City. Two thousand one hundred and two (78.3%) had emergency caesarean section while 584 (21.7%) had elective caesarean section. Of these, 2597 (96.7%) had general anaesthesia (GA) and 89 (3.3%) regional anaesthesia (RA). Within this period, 30 paturients (1.1%) were admitted to the ICU; one was after elective caesarean and 29 (96.7%) were after emergency caesarean section. Fifteen patients were admitted for anaesthesia-related complications, of which all were after caesarean section done under GA. The incidence of a major anaesthetic complication resulting in ICU admission was 15 in 2597 GA while it was zero in 89 RA (p < 0.01). Total maternal deaths in the ICU admissions were 11(36.7%); anaesthesia being directly the cause of death in 3 (27.3%) while non-anaesthetic factors accounted for 8 (72.7%) deaths. Emergency caesarean section and GA, were risk factors for anaesthesia-related morbidities after caesarean section. Preventable deaths due to poor laboratory support services and inadequate anaesthetic materials accounted for the anaesthesia-related mortalities.
Anesthesia, General↗
Experience with ambulatory anaesthesia in gynaecological patients.
Ambulatory surgical care is becoming a common feature in Nigeria. Reports on the role of anaesthesia on outcome of surgery in ambulatory setting are rather scanty. In a 24-month period all patients who had gynaecological operations on ambulatory setting were identified and their hospital records reviewed. Sociodemographic characteristics, intraoperative variables, postoperative outcome and postoperative pain management were studied. A total of 28 patients had anaesthesia for various gynaecological procedures. All the patients were in the age range of 20-41 years and American Society of Anaesthesiologists physical status 1. Majority of the patients (71.4%) arrived for day care admission. General anaesthesia with relaxant technique of anaesthesia was the most commonly used technique of anaesthesia (75.0%). Late completion of surgery accounted for 70% (n = 7) of late discharges. Postdural puncture headache (PDPH) was the only adverse outcome seen in our study. Ambulatory anaesthesia is safe, efficient and promising for gynaecological day care procedures.
Adult↗