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Results for “Placenta, Retained”

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PubMed2004

Minimally invasive management of an advanced abdominal pregnancy.

BACKGROUND: Advanced abdominal pregnancy is a rare, life-threatening condition that presents a number of challenges. CASE: A 29-year-old primigravida with 10 years of secondary infertility and a previous tuboplasty had a 21-week abdominal pregnancy treated with preoperative arterial embolization before laparoscopically assisted fetal delivery. Postoperatively, 4 cycles of methotrexate were administered at 50 mg/m2 intramuscularly every 3 weeks for the retained abdominal placenta. Subsequent spontaneous conception occurred, and a live, full-term infant was delivered by cesarean delivery 17 months later. No adverse sequelae were found during long-term follow-up. CONCLUSION: This report demonstrates successful minimally invasive management of an advanced abdominal pregnancy with a multimodal approach that included preoperative arterial embolization, laparoscopically assisted delivery, and judicious use of postoperative methotrexate.

Adult↗

PubMed2005

Postpartum hemorrhage after vaginal birth: an analysis of risk factors.

OBJECTIVE: To determine, in a single tertiary obstetric hospital, the incidence of and risk factors for postpartum hemorrhage (PPH) after a vaginal birth. METHODS: PPH was defined as measured blood loss greater than 1,000 mL and/or need for a transfusion. RESULTS: Over a 4-year period, 13,868 of 19,476 women delivered vaginally, with a PPH rate of 5.15%. Identified risk factors for PPH were Asian race, maternal blood disorders, prior PPH, history of retained placenta, multiple pregnancy, antepartum hemorrhage, genital tract lacerations, macrosomia (>4 kg), and induction of labor, as well as chorioamnionitis, intrapartum hemorrhage, still birth, compound fetal presentation, epidural anesthesia, prolonged first/second stage of labor, and forceps delivery after a failed vacuum. CONCLUSIONS: Identification of risk factors for PPH after a vaginal delivery may afford prophylactic treatment of such women with reduction of morbidity.

Adolescent↗

PubMed1986

The anaesthetist and the obstetric flying squad. Could complacency creep in?

The demands made upon the Bristol obstetric flying squad over the past 14 years have been analysed. During this period, the number of calls received per year has decreased dramatically. The reasons for this are discussed in the context of current obstetric practice. The management of retained placenta is reviewed. Of importance to anaesthetists is the gross reduction in the number of cases where it is necessary to give anaesthesia 'in the field'. This may lead to complacency and lack of familiarity with the equipment carried by the flying squad.

Anesthesia, Obstetrical↗

PubMed2006

Risk factors for testicular cancer--differences between pure non-seminoma and mixed seminoma/non-seminoma?

The origin of testicular germ cell cancer (TGCC) is believed to be carcinoma in situ cells developed in utero. Clinically, TGCCs are divided into two major histological groups, seminomas and non-seminomas, where the latter group includes non-seminomatous TGCCs with seminomatous components (mixed S/NS TGCC). Recent studies, however, have suggested that non-seminomas and mixed S/NS TGCCs could have certain differences in aetiology, and in this study the TGCCs were divided into three, rather than the conventional two histological groups. A large case-control study was undertaken on data on all live-born boys registered in the Medical Birth Registry of Norway during the period 1967-1998 (n=961 396). Among these were 1087 TGCC cases registered in the Cancer Registry of Norway until February 2004. We found several risk factors for TGCC, including low parity, low gestational age, epilepsy and retained placenta. Several of the variables studied seemed to be risk factors for specific histological groups, e.g. parity 0 vs. 2 and low gestational age being associated with increased risk of non-seminomas, but not of mixed S/NS TGCC, and low maternal age being associated with increased risk of mixed S/NS TGCC, but not of non-seminomatous TGCC. Therefore, our results might suggest that non-seminomas and mixed S/NS TGCCs have partially different risk factors, whose associations may be obscured by combining these two histological groups. The histological groups were not significantly different, however. Most of our findings on risk factors for TGCC are in agreement with at least some previous studies. An unexplainable exception is low birth weight being associated with reduced risk of TGCC in our study.

Adolescent↗

PubMed1994

Infants with single umbilical artery studied in a national registry. 3: A case control study of risk factors.

This case control study reports associations between single umbilical artery (SUA) in newborns and some maternal biological characteristics. The study is based on chromosomally normal singleton infants born in Sweden between 1983 and 1990. Information on the maternal characteristics studied was obtained prospectively. There were 2920 cases identified and 5840 controls were selected. An association was found with: previous perinatal death, retained placenta, placenta praevia, maternal diabetes, epilepsy and hydramnios. Increased odds ratios were seen also for spontaneous abortion and abruptio placentae but did not reach statistical significance. No association was found with previous induced abortion, involuntary childlessness, or the use of contraceptives after the last menstrual period.

Case-Control Studies↗

PubMed1990

Coagulation profile in different stages of pregnancy and under consideration of placental expulsion in dairy cattle.

It was the aim of the present study to determine different parameters of blood coagulation in dairy cattle in the course of gestation (n = 19) and during 9 days post partum (n = 40). The coagulation profile comprised prothrombin time, partial thromboplastin time, thrombin time, fibrinogen concentration, and platelet count. Prothrombin time was shorter in the 2nd month of gestation (13.9 s) than in the 7th (15.2 s) month. A reduction of partial thromboplastin time towards the end of gestation by approximately 4 seconds was statistically insignificant (p greater than 0.05). A significant change of fibrinogen concentration was established over a period of 10 days ante partum. Immediately before parturition, fibrinogen level (484 mg/dl) increased compared to one (325 mg/dl) and two (343 mg/dl) days before calving. Cows whose calves were developed per vias naturales displayed pronounced differences of fibrinogen concentration. Animals with retained placenta showed significantly higher fibrinogen concentrations than cows with normal expulsion of the placenta on all days.

Animals↗

PubMed1993

Analysis of 20,119 deliveries in Dhaka Medical College Hospital.

Data of 20,119 deliveries in Dhaka Medical College Hospital are presented. Dhaka Medical College Hospital is the chief referral hospital in Dhaka city. The 15% of patient were 18 years of age or below and 18% were above 35 years of age or above. The 48.22% were primaegravida and 51.78% were multigravida, of these 28% were grandmultigravida. The 89% had no previous antenatal checkup. The 92.72% had cephalic presentation, 65.52% had normal vaginal delivery, 21.07% had caesarean section, 11.18% had forceps delivery. Perinatal mortality during hospital stay was 143/1,000 deliveries, maternal mortality 2,510/100,000, mainly due to eclampsia. Complications during delivery were mainly in the form of ruptured uterus (1.10%), P.P.H. (1.06%), and retained placenta (3.88%).

Adolescent↗

PubMed1985

Homozygous alpha-thalassaemia: clinical presentation, diagnosis and management. A review of 46 cases.

Forty-six hydropic infants with homozygous alpha-thalassaemia born during a period of 10 years have been reviewed. The incidence was 1:1550 total births, and accounted for 81% of all non-immune hydrops. The male to female ratio was 1:1.4. There was increased incidence of anaemia, pregnancy induced hypertension, antepartum haemorrhage, malpresentation, prematurity, fetal distress, difficult vaginal delivery, caesarean section, retained placenta, postpartum haemorrhage and congenital abnormalities. Antenatal diagnosis by DNA hybridization with subsequent abortion of the affected fetuses is the best method to decrease maternal morbidity and to reduce the incidence of hydrops fetalis in couples at risk. For those with no previous history, but with early onset hypertension and/or polyhydramnios, sonography is useful in making an earlier diagnosis, and in reducing avoidable morbidity, because DNA analysis can be done before caesarean section and aggressive neonatal management is instituted.

Adolescent↗

PubMed1987

Postpartum haemorrhage--a continuing problem.

The factors responsible for postpartum haemorrhage (PPH) in singleton vaginal deliveries, not complicated by a retained placenta, were identified by comparing labour characteristics in 86 women who had a PPH (blood loss greater than 500 ml) with 351 women whose blood loss at delivery was less than 350 ml. Primiparity, induction of labour by amniotomy/oxytocin, forceps delivery, long first and second stages, oxytocin compared with syntometrine (oxytocin plus ergometrine maleate), as a prophylactic oxytocic, were identified as significant risk factors. Epidural analgesia contributed indirectly to an increase in the risk of postpartum haemorrhage. The changes in labour ward practice over the last 20 years have resulted in the re-emergence of PPH as a significant problem.

Amnion↗

PubMed1988

The effects of routine oxytocic administration in the management of the third stage of labour: an overview of the evidence from controlled trials.

Recent claims that routine active management of the third stage of labour increases rather than decreases maternal and neonatal morbidity have prompted us to conduct a systematic review of the relevant controlled trials. In this paper we have analysed data derived from a total of nine published reports of controlled trials in which an oxytocic drug was compared with either a placebo or no routine prophylactic. Oxytocic drugs used routinely appear to reduce the risk of postpartum haemorrhage by about 40% (typical odds ratio 0.57, 95% confidence interval 0.44-0.73) implying that for every 22 women given such an oxytocic, one postpartum haemorrhage could be prevented. The available data are insufficient to assess the possible effects of this policy on the incidence of retained placenta, hypertension and other possible adverse effects.

Clinical Trials as Topic↗

PubMed1996

A prospective cohort study of oxytocin plus ergometrine compared with oxytocin alone for prevention of postpartum haemorrhage.

OBJECTIVE: To determine the safety and efficacy of intramuscular oxytocin plus ergometrine compared to intravenous oxytocin for prevention of postpartum haemorrhage, and the significance of administration at the end of the second stage of labour compared with that after the third stage. DESIGN: A prospective cohort study. SETTING: A university affiliated tertiary medical centre. PARTICIPANTS: Two thousand one hundred and eighty-nine women delivering singletons during 40 consecutive weeks. MAIN OUTCOME MEASURES: Postpartum haemorrhage (> 500 ml), prolonged third stage (> 30 min), retained placenta (> 60 min), elevated blood pressure (systolic > 150 mmHg, diastolic > 100 mmHg). RESULTS: The rate of postpartum haemorrhage was not significantly different for oxytocin-ergometrine compared with oxytocin, when administered at the end of the second stage of labour (odds ratio 1.10, 95% confidence interval (CI) 0.75-1.61) or after the third stage (odds ratio 0.95, 95% CI 0.68-1.34). The patients receiving oxytocics at the end of the second stage of labour had significantly lower rates of postpartum haemorrhage, for both oxytocin-ergometrine (odds ratio 0.69, 95% CI 0.49-0.98) and oxytocin (odds ratio 0.60, 95% CI 0.41-0.87), compared with those treated after the third stage. CONCLUSION: Administration of oxytocin alone is as effective as the use of oxytocin plus ergometrine in the prevention of postpartum haemorrhage, but associated with a significantly lower rate of unpleasant maternal side effects. Oxytocics administered after delivery of the fetal head compared with after the placental expulsion are associated with a significantly lower rate of postpartum haemorrhage.

Adult↗

PubMed1996

A comparison of 600 and 200 mg mifepristone prior to second trimester abortion with the prostaglandin misoprostol.

OBJECTIVE: To compare the use of 600 and 200 mg mifepristone prior to second trimester termination of pregnancy with the prostaglandin misoprostol. DESIGN: A randomised study. SETTING: A Scottish teaching hospital. PARTICIPANTS: Seventy women undergoing legal induced abortion between 13 and 20 weeks of gestation. INTERVENTION: Administration of either 600 or 200 mg mifepristone 36 to 48 hours prior to prostaglandin. MAIN OUTCOME MEASURE: Induction-abortion interval. RESULTS: The geometric mean induction abortion interval was 6.9 (95% CI 5.8-8.4) h and 6.9 (95% CI 5.8-8.2) h in the 600 and 200 mg groups, respectively (no significant difference). The median dose of misoprostol was 1600 micrograms (three doses) in each group. Analgesic requirements and prostaglandin-related side effects were similar between groups. Overall, 11.4% of women required surgical evacuation of the uterus as a result of retained placenta. CONCLUSIONS: The dose of mifepristone used in second trimester abortion can be reduced from 600 to 200 mg.

Abortifacient Agents, Steroidal↗

PubMed1997

Randomised trial comparing a policy of early with selective amniotomy in uncomplicated labour at term.

OBJECTIVE: To compare two management policies: rupture of the fetal membranes when women are in normal labour or leave them intact as long as feasible. SETTING: The labour ward of a city university hospital. DESIGN: Automated randomised clinical trial. PARTICIPANTS: 1540 women in uncomplicated term labour. Data on labour duration, blood loss, oxytocin use and fetal condition were collected from 1132 women. Some data from nulliparous women has been presented earlier by the UK Amniotomy Group. MAIN OUTCOME MEASURES: Duration of labour, Apgar score, fetal morbidity and maternal morbidity including perineal injury, mode of delivery, epidural rates and the total number of vaginal examinations in the first stage of labour after amniotomy. INTERVENTIONS: Amniotomy at the next vaginal examination or amniotomy only if indicated. The median cervical dilatation at membrane rupture was 2 cm greater in the first group. RESULTS: A policy of routine amniotomy in labour had no measurable advantage over selective amniotomy for parous women (difference = 4 min) but shortened labour in nulliparous women by 1 h (Mann-Whitney U test: P < 0.05). There was a suggestion of a higher caesarean section rate (OR 1.9; 95% CI 0.9-3.5), and there were more vaginal examinations after membrane rupture in the group allocated routine amniotomy. There were no measurable differences in oxytocin use, fetal condition at birth, retained placenta rates, blood loss, pain or analgesia requirements. CONCLUSION: Routine amniotomy may shorten the first labour but not subsequent ones. There is a suggestion that routine surgical interference may be harmful by increasing the risk of caesarean section, and this agrees with data from other trials (common odds ratio 1.2; 95% CI 0.92-1.6).

Adult↗

PubMed2005

Misoprostol for second trimester pregnancy termination in women with prior caesarean section.

OBJECTIVE: To examine whether a previous caesarean section increases the risk for complications in women undergoing a mid-trimester pregnancy termination by labour induction. DESIGN: Retrospective analysis of case records between 1997 and 2002. SETTING: Fetal Medicine Unit of a large teaching hospital. POPULATION: One hundred and eight women with a previous caesarean section (study group) and 216 women without such a history (controls), who underwent a second trimester termination of pregnancy. METHODS: All the terminations were performed between 17 and 24 weeks of gestation by using 400 mug of oral administration of misoprostol in combination with 400 mug of intravaginal misoprostol. The same dose of intravaginal misoprostol was repeated every 6 hours for a maximum of five doses. MAIN OUTCOME MEASURES: Severe haemorrhage requiring blood transfusion, post-abortal infection, retained placenta and uterine rupture. RESULT: Complications occurred in 16 out of 108 women of the study group (15%) and in 26 out of 216 of the controls (12%), with only one ruptured uterus in the control group. CONCLUSION: We found no evidence that a previous caesarean delivery affects the incidence of complications when women with such a history undergo a mid-trimester pregnancy termination with misoprostol.

Abortifacient Agents, Nonsteroidal↗

PubMed2006

A randomised trial of carbetocin versus syntometrine in the management of the third stage of labour.

OBJECTIVE: Syntometrine is an effective uterotonic agent used in preventing primary postpartum haemorrhage but has adverse effects including nausea, vomiting, hypertension and coronary artery spasm. Carbetocin is a newly developed long-acting oxytocin analogue that might be used as an uterotonic agent. We compare the efficacy and safety of intramuscular (IM) carbetocin with IM syntometrine in preventing primary postpartum haemorrhage. DESIGN: Prospective, double-blinded, randomised controlled trial. SETTING: Delivery suite of a university-based obstetrics unit. POPULATION: Women with singleton pregnancy achieving vaginal delivery after and throughout 34 weeks. METHODS: Three hundred and twenty-nine eligible women were randomised to receive either a single dose of 100 microgram IM carbetocin or 1 ml IM syntometrine (a mixture of 5 iu oxytocin and 0.5 mg ergometrine) at the end of second stage of labour. MAIN OUTCOME MEASURES: Difference in haemoglobin drop measured 2 days after delivery between the two groups. RESULTS: There was no difference in the drop of haemoglobin concentration within the first 48 hours between the two groups. The incidence of additional oxytocic injections, postpartum haemorrhage (blood loss > or = 500 ml) and retained placenta were also similar. The use of carbetocin was associated with significant lower incidence of nausea (relative risk [RR] 0.18, 95% confidence interval [CI] 0.04-0.78), vomiting (RR 0.1, 95% CI 0.01-0.74), hypertension 30 minutes (0 versus 8 cases, P < 0.01) and 60 minutes (0 versus 6 cases, P < 0.05) after delivery but a higher incidence of maternal tachycardia (RR 1.68, 95% CI 1.03-3.57). CONCLUSIONS: IM carbetocin is as effective as IM syntometrine in preventing primary postpartum haemorrhage after vaginal delivery. It is less likely to induce hypertension and has a low incidence of adverse effect. It should be considered as a good alternative to conventional uterotonic agents used in managing the third stage of labour.

Adult↗

PubMed1980

Single dose extra-amniotic prostaglandin gel for midtrimester termination of pregnancy.

The efficacy of a single dose of prostaglandin F2 alpha gel instilled into the extra-amniotic space to induce termination of pregnancy in the second trimester has been assessed and compared with intra-amniotic prostaglandin F2 alpha and with an extra-amniotic infusion of prostaglandin F2 alpha combined with intravenous oxytocin. There was no significant difference between the methods in time taken to abortion, incidence of retained placenta, need for blood transfusion, or rate of sepsis. Single dose extra-amniotic prostaglandin gel is recommended as a safe, effective, and convenient method of midtrimester termination of pregnancy.

Abortion, Induced↗

PubMed1988

Primary postpartum haemorrhage in Tasmania 1982-1986.

Primary postpartum haemorrhage remains a significant problem in modern obstetric practice. The incidence and factors associated with postpartum haemorrhage in Tasmania over a 5-year period were studied. The mode of delivery, anaesthesia, birth-weight, induction and augmentation of labour, multiple pregnancy, antepartum haemorrhage and hypertension were found to be important factors. The incidence of retained placenta was not considered in this study.

Birth Weight↗

PubMed1991

The impact of multiple induced abortions on the outcome of subsequent pregnancy.

The obstetric outcome of 285 women with a history of previous multiple induced abortions is compared to that of 285 age matched primigravidas. In the study group, 219 women had 2 previous induced abortions and 66 had 3 or more, the maximum number being 8. There was a higher incidence of unmarried women and smokers in this group but a lower incidence of uneducated women. There was no difference in the incidence of antenatal complications between the 2 groups. The mean gestation at delivery, duration of labour and mode of delivery were comparable. There was an increased incidence (p less than 0.01) of retained placenta in the subgroup of women with 3 or more previous induced abortions. There were no maternal or perinatal deaths. The mean birth-weight was comparable and there were no infants weighing less than 1,500 g in either group. We conclude that multiple previous induced abortions appear to have minimal impact on the obstetric outcome of subsequent pregnancy in this population, and in the absence of other risk factors there is no need to alter standard obstetric management in this group of women.

Abortion, Induced↗