Biomedical subjects
Publications and source records attributed to P Scheidel.
Recently a number of authors have published their results of conservative treatment in tubal gestations. Numerous operative techniques have been described. This review tries to summarize the different operative approaches under special consideration of microsurgical techniques in regard to the authors experience. As a general rule conservative management of tubal gestation can be performed more extensively in the future.
Gamete intrafallopian transfer has been performed since April 1985 in our hospital. In patients with a long history of infertility despite proved tubal patency, the follicles present at laparoscopy are aspirated. The oocytes thus obtained are introduced together with the prepared sperm via a special catheter directly into the ampulla. We would like to report on the first pregnancy for which we used this technique.
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Between October 1978 and December 1980 165 diagnostic laparoscopies were carried out because of the suspected diagnosis of primary tubal infertility. In this preselected series 27.9% of the cases had normal findings. It was remarkable that the previous diagnosis was not confirmed in 21 cases which had a prior infertility work-up. In 17 of these cases tubal occlusion was diagnosed by laparoscopy or hysterosalpingography but was not confirmed by the repeat laparoscopy. In addition 1 case of tubal tuberculosis and 1 case of tubal anomaly were detected which were missed with the prior work-up. Because of the findings in this series the repeat diagnostic laparoscopy prior to micro-surgical reconstruction of the fallopian tubes is necessary and the referring clinics should show comprehension for the repeat laparoscopy prior to micro-surgery. In the sequence of diagnostic test, laparoscopy it selected prior to hysterosalpingography.
A thirty-nine year old gravida 2 was allowed to have a trial of labor 4 years after Cesarean section. A continuous epidural anaesthesia was applied. During the well placed epidural anaesthesia pain in the cesarean section scar area started. Despite a normal fetal heart rate and normal intra-uterine pressure, normal pulse and blood pressure the trial of labor was discontinued and a repreat caesarean section for impending rupture of the uterus was performed. During the caesarean section a 2 cm. long concealed rupture without bleeding was found in the old scar. The importance of stringent criteria for indications for continuous epidural anaesthesia is stressed. The lowest effective dose of local anaesthesia need to be used. Continual intensive monitoring is necessary in order to detect a pathological pain during a continuous epidural anaesthesia.
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Explore the source record for details and available documents.
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Few procedures are less standardised than the procedure in case of pre-labour rupture of the membranes at term (PROM). We propose that management should be reviewed regularly on the basis of one's own data and be modified accordingly if necessary. For the duration of three months we analysed 400 pregnancies retrospectively. Patients with PROM were observed expectantly for 24 hours. If there were no spontaneous uterine contractions, labour was induced, depending on the degree of cervical dilatation. 10 percent of the cases studied had PROM. Of these a high proportion of 73 percent were primigravida, likewise 73 percent had an unripe cervix. The average time between PROM and delivery was 27 h. 50 percent of the babies were born 24 h after PROM. If delivery occurred more than 24 h after PROM, the rate of caesarean section (15 vs. 30 percent), the rate of forceps deliveries (11 vs. 20 percent), the rate of amnionitis (16 vs. 35 percent) and the number of admissions to the newborn-ICU (16 vs. 25 percent) almost doubled. The patients were examined vaginally relatively often prior to delivery (up to 18 times, with a mean of 8 times). We therefore recommend active management 6-8 h after PROM, should there be no onset of spontaneous uterine contractions. This is particularly beneficial to primigravida with an unripe cervix.
The problem of postoperative adhesions remains unsolved. The formation of readhesions after tubal reconstructive surgery reduces the success rate. We have developed a modified uterine horn model in the rat to study the influence of peritoneal transplants on readhesion formation. A total of 58 rats were operated. In 25 animals (group III) the uterine horn was scratched on both sides and then sutured together. During relaparotomy 14 days later the tight connection between both sides was cut. The resulting defect was covered by a peritoneal transplant on one side (group IIIb) and was left open on the control side (group IIIa). After 14 days the presence or absence of adhesions was explored. There was a significant difference (p < .001) between the covered (28%) and uncovered (84%) peritoneal defects with respect to incidence of adhesions. To compare the different characteristics of visceral and parietal peritoneum, a pelvic sidewall defect was induced in 33 animals. There was no significant difference between covering the defect by a peritoneal transplant (group II; 42.9%) and the control side (group I; 33.3%). These data suggest that defects on visceral peritoneum should be closed to prevent adhesion formation. The incidence of adhesions after injury of parietal peritoneum seems to be much lower and of less clinical significance.