Septic abortions and their management.
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Abortion, Induced↗
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[Contribution to the study of epidemiology of induced abortion].
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Abortion Applicants↗
Methods of midtrimester abortion.
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Abortifacient Agents↗
[Selective embryonic or fetal reduction by surgical transvaginal ultrasonography].
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Biology↗
Regulations on the appointment of physicians for abortion or ligation procedures.
These Regulations are made pursuant to Article 5 of the Eugenic Protection Law, 1984. They provide the following: a) physicians must undergo an examination of their qualifications at both the local and national levels; b) those applying to perform abortions must have specialized in gynecology and obstetrics for between two and four years, depending on the grade of hospital in which they have practised; c) those applying to perform ligations must have specialized in gynecology and obstetrics, surgery, or urology for between two and four years, depending on the grade hospital in which they have practised, or have signed a contract to perform ligations with a health department; d) physicians who have been approved to perform abortions or ligations will receive a certificate, which is to be placed in a conspicuous place at work; e) a certificate is not to be issued or, if issued, revoked, when a physician's licence has been suspended, when the licence is withheld for a penalty, or when the physician has not reported case records monthly as required by law.
Abortion, Induced↗
The Departments of Medical Eelectronics, St. Bartholomew's Hospital--the first ten years.
The organisation of an electronics department required to support the work of a large teaching hospital is described. The research and development programme involves the interaction of graduates from many disciplines since problems can emerge from any of the specialities, for example general surgery, obstetrics and gynaecology, clinical neurophysiology. Examples from the research and development programme of the department are described in order to illustrate the range of medical electronic techniques needed to provide adequate support for the clinical research programmes which have received support from the Joint Research Board of the Hospital and Medical College.
Biophysical Phenomena↗
[Fatal complications in pre-eclampsia and eclampsia].
OBJECTIVE: Analysis of preeclampsia and eclampsia--one of the major contributor to life-threatening maternal morbidity frequently leading to maternal mortality in the Czech Republic till late 70's. Our goal was to mention major causal links in clinical courses of individual maternal death and to highlight main mistakes and faults, and to provide frequencies and basic characteristics of risk groups. DESIGN: Retrospective epidemiological study. SETTING: Department of Obstetrics and Gynecology of the 1st Medical School of Charles University and General University Hospital, Prague. Institute for the Care of Mother and Child, Prague-Podoli; 1st Intern Department of the 1st Medical School of Charles University and General University Hospital, Prague. METHODS: Analysis of 31 cases of maternal deaths associated with severe preeclampsia and eclampsia in the Czech Republic during 1978-2000, using a database of 470 maternal deaths during the observed period. We analyzed clinical course with special attention to obstetrical surgery and clinical management. We considered timelines of life-threatening events, age of mother, parity, and place of death. RESULTS: There were 36 maternal deaths associated with severe preeclampsia and eclampsia in the Czech Republic in 1978-2000, contributing 7.7% to total maternal mortality. Group A1 was 5th most frequent cause of maternal death. We analyzed 31 cases closely related to severe preeclampsia and eclampsia. During 1978-1990 there was 1 death per 74,263 live-born babies in this category, while during 1991-2000 we observed only 1 death per 171,137 live-born babies. Clinical management was not adequate in 15 cases of death (48%) and content of care did not reflect possibilities of prevention, diagnosis and therapy. Severe preeclampsia and eclampsia was more frequent among older women and multiparae. First group (61%) is composed of women with manifest convulsions, 25% of them experienced convulsion after delivery, and only few cases had mild preeclampsia ante partum. Eclampsia with convulsions leading to coma were in 10 cases complicated with DIC, two cases in this group had premature separation of placenta. Besides classic symptoms of preeclampsia there were within this group 5 cases of multiple pregnancy, history of unstable hypertension, hepatopathy in previous pregnancy and chronic nephrosis. The second group (39%) were cases without convulsions. These cases were complicated with severe liver disorders and renal failure, and 5 cases of intra-cranial hemorrhage. Several cases had combination of symptoms. DIC was present in 6 cases. In both groups there were 5 cases with hemorrhagic skin symptoms, thrombopenia, symptoms of DIC and liver and renal failure, which would fall into HELLP syndrome according to current classification. The most of women died during the postpartum period (87%) mostly after emergency operative deliveries. The fact that no women died during pregnancy indicates the effort to perform life-saving operative delivery. Forty two percent of women were in term. Especially at the beginning of observed period we noticed tendency to prolong gestation in order to save the baby. The mortality of fetuses or newborns was 71%. Operative deliveries accounted for 71%, the majority of them were caesarean sections. More than 50% of cases were operated in coma. We indicate major mistakes and failures in organization of care, primary prevention, diagnosis, and consequent care. CONCLUSION: Positive results in area of maternal deaths in association with severe preeclampsia and eclampsia during last 10 years are due to improved diagnostic and therapeutic measures in our field, especially in neonatology, because obstetricians currently terminate pregnancies early than before while symptoms of preeclampsia get worse. We focus on early recognition of symptoms of coagulopathy in combination with symptoms of preeclampsia, especially on early detection and treatment of HELLP syndrome.
Adult↗
[Ureterovaginal fistulas: diagnosis and surgical tactic. Apropos of 19 personal cases].
Personal experience of the treatment of 19 ureterovaginal fistulae, observed from september 1987 to june 1991 on 17 patients in Africa is described and analysed. Occurring after gynecological or obstetrical surgery, the main cause is hysterectomy (82.3%). Elements for diagnosis were: the appearance of a urine leak, which in most cases came rapidly, echography, and most important, intravenous urography (IVU). Surgical management in all of the cases was mainly aimed at conservation. One end-to-end anastomosis and 18 cuff reimplantations were performed, combined in 2 cases with a sub-mucus tunnel (Politano), in 14 cases combined with a tubular Boari bladder flap (wherein 1 case was bilateral), 3 combined with a bladder psoas hitch and 2 with an isolated ileal graft (ileo-ureterocystoplasty). One case of vesicouterine fistula and 4 associated vesicovaginal fistulae benefited from a simultaneous surgical operation. In this study of 17 patients treated, except for one patient deceased 14 months following a neoplastic recurrence, the results were excellent. 16 patients were cured. Follow-up extended to more than a year and have shown the perfect conservation of the excretory ducts in all of the cases studied. The cuffed ureterovesical reimplantation combined with a tubular bladder plasty definitively seem to be a most reliable management technique for all ureter injury encountered. While allowing the preservation of the kidney located just below, it has, in particular, prevented ureter stenosis. If the use of simpler methods (psoas bladder hitch) may be sufficient for some cases, the use of more complex method (ileoureterocystoplasty) for other cases, may be indispensable.
Adolescent↗
PRIMITIVE AFRICAN MEDICAL LORE AND WITCHCRAFT.
This article presents a comprehensive study of the methods, practices, equipment, and paraphernalia of African witch doctors in carrying out primitive medical practices. The chief tribes studied are the Azandes of the Sudan, the Manos of Liberia, the Congo tribes, the Bundas of Angola, and the Zulus and other Bantu tribes of South Africa. Primitive beliefs and customs are discussed only insofar as they have a direct bearing on medical practices. The medical practices considered deal mainly with the application of general remedies for ailments and diseases, but certain specialized fields such as obstetrics, surgery, treatment for fractures, and dentistry are also included. Primitive medicaments are presented with reference to their application for various illnesses. An alphabetical list of these medicaments is given at the end of the article.
Africa↗
Epidural blockade: a multifaceted anesthesia tool.
The search for an optimal analgesic and route of administration continues. The development of the epidural route of administration of local anesthetic solutions and opioids approaches this ideal. In this article, the author details why epidural blockade is a multifaceted anesthetic technique useful in obstetrics, surgery, and pain therapy.
Anesthesia, Epidural↗
A kind of Mozart of medicine: Joseph Plenck (1735-1807).
This is a tribute to one of the fathers of modern European dermatology and venereology, Dr Joseph Plenck, the Viennese protodermatologist of two hundred years ago, 1735-1807, who was professor and secretary of the Imperial Medical Josephine Academy, where today is the Institute for the history of medicine. Plenck introduced the systematization of dermatovenereological diseases based on their paradigmatic differences, which is deemed as "the only (system) with pretensions to accuracy". A man of diversified interests and a fruitful author, he wrote many treatises covering various fields from dermatology, venereology, and dentistry to surgery, obstetrics, anatomy, pediatrics, pharmacology, and botany. This remarkable physician definitely left a deep trace in the history of dermatology and venereology, and marked the transition from text-based to visually dependent culture in the field of dermatovenereology.
Austria↗
[Uretero-vaginal fistulas: diagnosis and operative tactics. Apropos of 19 personal cases].
Personal experience of the treatment of 19 uretero-vaginal fistulae, observed from september 1987 to june 1991 on 17 patients in Africa is described and analysed. Occurring after gynecological or obstetrical surgery, the main cause is hysterectomy (82.3%). Elements for diagnosis were: the appearance of a urine leak, which in most cases came rapidly, echography, and most important, intravenous urography (IVU). Surgical management in all of the cases was mainly aimed at conservation. One end-to-end anastomosis and 18 cuff reimplantations were performed, combined in 2 cases with a sub-mucus tunnel (Politano), in 14 cases combined with a tubular Boari bladder flap (wherein 1 case was bilateral), 3 combined with a bladder psoas hitch and 2 with an isolated ileal graft (ileo-uretero-cystoplasty). One case of vesicouterine fistula and 4 associated vesicovaginal fistulae benefited from a simultaneous surgical operation. In this study of 17 patients treated, except for one patient deceased 14 months following a neoplastic recurrence, the results were excellent. 16 patients were cured. Follow-up extended to more than a year and have shown the perfect conservation of the excretory ducts in all of the cases studied. The cuffed ureterovesical reimplantation combined with a tubular bladder plasty definitively seem to be a most reliable management technique for all ureter injury encountered. While allowing the preservation of the kidney located just below, it has, in particular, prevented ureter stenosis. If the use of simpler methods (psoas bladder hitch) may be sufficient for some cases, the use of more complex methods (ileo-uretero-cystoplasty) for other cases, may be indispensable.
Adolescent↗
Angiographic embolization for emergent and prophylactic management of obstetric hemorrhage: a four-year experience.
BACKGROUND: To retrospectively evaluate the efficacy and safety of emergent and prophylactic arterial embolization for obstetric hemorrhage within the past 4 years. METHODS: We retrospectively collected 21 obstetric patients with treatment of selective arterial embolization between 1999 and 2002. Two groups of patients were identified. The first group consisted of 15 patients who experienced postpartum hemorrhage and underwent emergent embolization. The second group was made up of 6 patients who underwent prophylactic embolization with risk factors of severe obstetric bleeding. They had abnormal placentation antepartum diagnosed and accepted termination of pregnancy followed by hysterectomy. RESULTS: In the first group, 12 of 15 cases had a favorable outcome treated by single embolization session. One patient expired 4 days after embolization due to severe disseminated intravascular coagulopathy and multiple organ failure. One retained placenta with recurrent bleeding was controlled by repeated selective arterial embolization. One uterine subinvolution with persistent mild bleeding and genital tract infection was improved by conservative treatment. Further surgical procedure was not necessary for all cases. One woman delivered her next baby 13 months after embolization. In the second group, all women had abnormal placentation with histopathological confirmation, including 1 accreta, 3 increta, and 2 percreta. No immediate complication was noted after embolization. The estimated blood loss during operation ranged from 300 to 3000 mL (mean, 1770 mL). CONCLUSIONS: Our study indicates that selective arterial embolization should be the early management for intractable postpartum hemorrhage after conservative treatment fails and before more invasive surgical intervention is considered. Our experience also confirms the effectiveness and safety of prophylactic selective arterial embolization for anticipated high morbidity or mortality of obstetric surgery.
Adult↗
A new approach for the treatment of bacterial vaginosis: use of polyhexamethylene biguanide. A prospective, randomized study.
BACKGROUND: Bacterial vaginosis (BV) is the most common vulvovaginal infection and represents the 35% of all the infections occurring in women in the reproductive age. It is well recognised that serious forms of BV can induce several complications among women undergoing gynaecologic or obstetric surgery, having pelvic inflammatory diseases, temporary or absolute infertility, miscarriage and abortion. At present, the clinical treatment of choice of BV is the use of systemic or local (gel or cream) metronidazole and clindamycin, though systemic use has some limitations due to side-effects and contraindications. Polyhexamethylene biguanide (PHMB) is a new bi-biguanide compound having a broad spectrum activity and low toxicity, that have been successfully utilized in ophthalmology and dentistry. Aim of this study was to evaluate the efficacy and tolerability of a single-dose vaginal administration of a PHMB vaginal gel in the treatment of BV in comparison to clindamycin vaginal cream. METHODS: One-hundred and ten patients affected by BV were treated with PHMB vaginal gel in single administration or clindamycin vaginal cream 1 daily administration for 7 days. RESULTS: We demonstrated the therapeutic efficacy of mono-dose administration of a vaginal solution containing PHMB in BV treatment; this efficacy is similar to the one shown in antibiotic therapy. Furthermore, this product was well tolerated by all treated patients. CONCLUSIONS: Mono-dose PHMB treatment should be regarded as the therapy of choice for BV, using clindamycin and metronidazole only for relapses treatment.
Administration, Intravaginal↗
[Analysis of maternal mortality in the Czech Republic in 2001].
OBJECTIVE: Analysis of maternal mortality in the Czech Republic in 2001. DESIGN: Retrospective statistical and clinical analysis. SETTING: Mother and Child Care Institute, Prague-Podoli. METHODS: We used database of 9 cases of maternal deaths in the Czech Republic during 2001 to analyze their causes, clinical courses especially related to obstetrical surgery, adequacy of provided care, and characteristics of their occurrence. RESULTS: There were total of 9 reported maternal deaths in pregnancy, during labor or within 42 days after delivery in the Czech Republic in 2001. During the same period there were 90,715 live births in the Czech Republic, and Pregnancy-related mortality ratio (A+B+C) was 0.0992/1000, i.e. 9.92 deaths per 100,000 live births. This is about 1.08/1000 better than in 2000 (the table 5 demonstrates the development of maternal mortality during the last 11 years). One reported death was unrelated to gestation (category C), therefore adjusted maternal mortality rate (A+B) was 0.0882/1000, i.e. 8.82 deaths per 100,000 live births versus 9.9 deaths per 100,000 live births in 2000. Group A (specific risk-direct maternal mortality) contributed to adjusted maternal mortality by 5 maternal deaths and direct maternal mortality was 5.5 per 100,000 live births. Group B (non-specific risk-undirect maternal mortality) contributed by 3 maternal deaths and undirect maternal mortality was 3.3 per 100,000 live births.
Adult↗
A dual-chambered syringe that allows identification of the epidural space using the loss of resistance technique with air and with saline.
BACKGROUND AND OBJECTIVES: Each of the two most widely used techniques for identification of the epidural space, the loss of resistance technique with air and the loss of resistance technique with liquid, has certain advantages and disadvantages. A new syringe is described that has two chambers, one to contain air and the other to contain liquid, to combine the advantages of air with the advantages of liquid, and to prevent the disadvantages of each. METHODS: Twenty consecutive adult patients scheduled to receive epidural injections for surgery, obstetrics, or pain control were selected for study. This was an open study, and the EpIdent syringe was used as the only means of identifying the epidural space in every case. RESULTS: The EpIdent syringe easily and effectively identified the epidural space in all of the patients, with no adverse or unpleasant side effects. Successful identification of the space was documented by the production of adequate anesthesia after the injection of an appropriate volume or local anesthetic. There were no complications. CONCLUSIONS: The successful use of the EpIdent syringe in this preliminary study of 20 patients indicates that it provides a simple, safe, and effective means of identifying the epidural space. It allows the use of a plastic syringe (instead of glass) and avoids the unpleasant or untoward effects associated with currently used loss of resistance techniques.
Air↗
[Ultrasonically verified vesicouterine fistula].
We report a case of a vesicouterine fistula occurring after a Caesarean section. There was a noticeable delay in recognizing the fistula, which was, however, clearly visible on a vaginal ultrasound scanning. When urinary incontinence is developed after gynaecologic or obstetric surgery, a fistula must be suspected.
Cesarean Section↗
Partial colectomy for treating acquired megacolon in long-tailed macaques.
A syndrome presenting as gross abdominal distension and diagnosed as acquired megacolon was observed in five adult female long-tailed macaques. Gastrointestinal signs included diarrhea, mucus in the stool, anorexia, and failure to pass stool, with repeated episodes of extreme abdominal distension and accumulation of gas and feces in greatly enlarged colons. Medical management was unsuccessful. A partial colectomy with a standard end-to-end colonic anastomosis was performed to remove the section of distended colon in each animal. Histologically, affected colons had degeneration and fibrosis, primarily in the longitudinal layer of the lamina muscularis. Hemograms, serum chemistries, and histopathologic features were not diagnostic of a specific etiology for megacolon. Four of five animals had undergone at least one obstetrical surgery. Two of these had the first episode of colonic distension within 3 days postoperatively. Intra-abdominal adhesions were noted during exploratory surgery in all animals. Three of five had colonic volvulus observed during colectomy. Recovery post-colectomy was uneventful and animals remained free of clinical signs of megacolon.
Animals↗