Obstetric anaesthetic and analgesic services in wales.
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Biomedical subjects
Publications and source records attributed to A D Noble.
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A 27-year-old patient who became pregnant whilst fitted with an intrauterine contraceptive device developed an intrauterine Candida albicans infection and aborted. The diagnostic (and other inconspicuous) features of C. Albicans infection in the fetus are described. The presence of the intrauterine contraceptive device may have predisposed to the establishment of the infection.
In a comparison of danazol, and mestranol with norethynodrel (Enavid, Searle) in the treatment of endometriosis danazol was shown to be superior. Danazol is however relatively ineffective when large tumours or extensive adhesions are present and such patients will usually need a surgical operation. Women who have completed their families and who have severe symptoms will be better treated by hysterectomy. Treatment with danazol is indicated for young women with mild or moderate endometriosis. Danazol treatment may also be given postoperatively after conservative operations.
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Details of the menstrual cycles in 504 women were recorded before laparoscopic sterilization with a spring-loaded clip and at six months and one year after the procedure. The operation did not affect the length of the menstrual cycle or duration of menstrual flow, nor the patient's assessment of the amount of blood losss or the incidence of dysmenorrhoea. The previous method of contraception was significantly related to subsequent menstrual patterns.
Ultrasound examination was done on 442 women early in pregnancy. If there was a discrepancy the date of delivery calculated from ultrasound readings was preferred to that calculated by traditional means. As a result of this policy induction for planned caesarean section was postponed or cancelled in 10.4% of cases. In 9.7% of women the menstrual history was unreliable and the ultrasound measurement was used to estimate the date of delivery. Thus in 21.1% of pregnancies the early ultrasound measurement decided when or whether labour was to be induced. In women induced for postmaturity there was no increase in prolonged labour or need for caesarean section. There were no cases of neonatal respiratory distress and neonatal jaundice was less common than it was when the onset of labour was spontaneous. This evidence suggests that neonatal jaundice is not caused by induction of labour or by the agents used. The low frequency of jaundice in this series is thought to be due to accurate prediction of the expected date of delivery and consequent exclusion of premature babies born to "postmature" women.
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The frequency of late sequelae in 454 patients sterilised by laparoscopy and diathermy or by abdominal tubal ligation was compared with that in 154 controls whose husbands had had a vasectomy. Results showed an increase in menstrual loss and pain with menstruation in the sterilised groups, especially if this had been done by diathermy and division under laparoscopic control.