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Michael L Stitely

Publications and source records attributed to Michael L Stitely.

5 recordsLinked to original sources
PubMed2005

Labor with abnormal presentation and position.

Abnormal presentation and position are encountered infrequently during labor. Breech and transverse presentations should be converted to cephalic presentations by external cephalic version or delivered by cesarean section. Face, brow, and compound presentations are usually managed expectantly. Persistent occiput transverse positions are managed by rotation to anterior positions and delivered as such. Occiput posterior positions can be delivered as such or rotated to occiput anterior positions. As with any position or presentation, an obstetrician should not hesitate to abandon any rotational or operative vaginal procedure and proceed to cesarean delivery if rotation or descent does not occur with relative ease.

Breech Presentation↗
PubMed2002

Pyometria after hemostatic square suture technique.

BACKGROUND: The square suture technique to achieve hemostasis for postpartum hemorrhage has been described in the medical literature. In a prior report of 23 cases, there were no complications from the technique. CASE: A young woman with an gravida 1 para 0 with an uncomplicated prenatal course presented at 40 weeks' estimated gestational age in active labor. Cesarean delivery was performed for arrest of dilatation and was complicated by postpartum hemorrhage unresponsive to medical therapy and uterine artery ligation. Several hemostatic square sutures were placed, obtaining hemostasis. The patient presented 4 weeks postpartum with pain and mucopurulent discharge. Pyometrium was discovered at the time of dilation and curettage. CONCLUSION: Pyometrium may result from the use of hemostatic square suture technique for control of postpartum hemorrhage.

Female↗
PubMed2002

Early intrauterine pregnancy failure: a randomized trial of medical versus surgical treatment.

OBJECTIVE: The purpose of this study was to determine whether medical treatment of early pregnancy failure represents a reasonable alternative to surgical therapy. STUDY DESIGN: Patients who were diagnosed with pregnancy failure before 12 weeks of gestation were randomly assigned to receive either medical (intravaginal misoprostol) or surgical therapy (dilatation and curettage). In the medical arm of the study, 800 microg of misoprostol was placed within the posterior vaginal fornix. Patients subsequently were seen 24 and 48 hours after the initial dosing; intravaginal misoprostol was readministered only if ultrasound images revealed evidence of persistent pregnancy tissue. By 72 hours after initial study entry, if either a gestational sac or placental tissue was present, the medical treatment was considered a failure, and uterine curettage was performed. Statistical analysis was performed with the two-tailed unpaired t test, chi(2) analysis, Fisher exact test, and Mann-Whitney U test; a probability value of <.05 was considered statistically significant. RESULTS: A total of 50 women were enrolled, with 2 patients in the surgical arm experiencing spontaneous pregnancy loss before their scheduled procedures. Twenty-five women received medical therapy; 25 women were randomized to surgical procedure. Fifteen patients in the medical group (60%; 95% CI, 0.41-0.79) had successful pregnancy termination and did not require curettage. There were no significant differences between the medical and surgical groups with respect to either posttreatment hematocrit level or the time needed to achieve negative human chorionic gonadotropin test results. CONCLUSION: Intravaginal misoprostol is an effective agent for the treatment of early pregnancy failure. Medical treatment of early pregnancy failure represents a reasonable alternative to immediate surgical therapy.

Abortifacient Agents, Nonsteroidal↗
PubMedDate not supplied

Laparoscopic removal of a rudimentary uterine horn in a previously hysterectomized patient.

BACKGROUND: The unicornuate uterine anomaly is often difficult to diagnose and usually low on the list of differential diagnoses for pelvic pain and dysmenorrhea. The authors present a case of a rudimentary uterine horn as a cause for continued pelvic pain and dysmenorrhea in a previously hysterectomized woman. CASE REPORT: A 43-year-old woman, gravida 1, para 1, presented for evaluation of right lower quadrant pain of several years' duration. Her past surgical history was significant for multiple prior laparoscopies and a vaginal hysterectomy. Radiographic studies revealed a mass in the right lower quadrant. Laparoscopy revealed a solid mass in the right pelvis that was diagnosed as a rudimentary uterine horn. CONCLUSION: Uterine anomalies, although uncommon, should be thought of as part of the differential diagnosis for pelvic pain and dysmenorrhea. A thorough inspection of the pelvis should be performed at the time of any operative procedure for abdominal pain.

Adult↗