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PubMed1987

Major ambulatory surgery of the gynecologic and obstetric patient.

Many gynecologic and obstetric procedures can be done on an ambulatory basis. There is little difference in care between ambulatory and inpatient surgery during the preoperative and intraoperative periods. Thus, the primary deciding factor as to the appropriateness of ambulatory care rather than hospitalization lies in the postoperative requirements. These include the type and amount of analgesia that will be required, the intensiveness of nursing care needed, the need for unusual postoperative monitoring, the potential for complications, and the necessity for frequent postoperative evaluation by the surgeons.

Ambulatory Surgical Procedures↗
PubMed1981

Factors influencing morbidity in termination of pregnancy.

This study analyzes the morbidity of therapeutic abortion and identifies predisposing factors. A retrospective case evaluation of 2,105 pregnancy terminations was performed. Major complications occurred in 5% of those undergoing curettage procedures, 41% of women undergoing prostaglandin amnioinfusion, and 17% of those who had hysterotomy as a method of abortion. Age, parity, and history of previous pregnancy termination, had little effect on morbidity. Surgical/technical factors and reliance on amnioinfusion and hysterotomy as procedures of choice for pregnancy termination contributed significantly to the high morbidity rates. This contribution, however, was overshadowed by the influence of patient delay, physician delay, and limited abortion facilities, resulting in 35.4% of pregnancy terminations being performed in the midtrimester. Improvements in abortion technique may lower the incidence of complications, but the need for more appropriate facilities is emphasized.

Abortion, Induced↗
PubMed1991

Rupture of the gravid uterus: a review.

A total of 105 patients were treated for ruptured gravid uteri at the Kenyatta National Hospital, Nairobi, Kenya, over a five year period, January, 1984 to December, 1988. During the same period, there were 44,156 deliveries, giving an incidence of uterine rupture of 1:425 deliveries. Of these, records for 95 patients were traced and analysed, and the results are presented here. Majority (61.0%) of these patients were aged less than 30 years, and 62.1% were gravida 5 or less. 54 (56.8%) of them had rupture of scarred uteri, 33 (34.7%) had spontaneous rupture, while 8 (8.4%) had traumatic rupture. 56 (59.0%) ruptured while at the Kenyatta National Hospital. Repair of the uterus without tubal ligation was the treatment offered to most of them, while total abdominal hysterectomy was rarely done. The perinatal case fatality rate was 60% and there were two maternal deaths giving a maternal case fatality rate of 2.1%. Factors associated with uterine rupture at the Kenyatta National Hospital are discussed, and possible ways of reducing the incidence suggested.

Adolescent↗
PubMed1995

Intrauterine adhesions.

Anticipation and suspicion are critical aspects to any discussion of intrauterine adhesions. Curettage between the second and fourth week postpartum is more likely to cause adhesions than is any other endometrial trauma. Infertility, recurrent abortion, or menstrual aberrations after any uterine trauma should cause the physician to suspect the presence of intrauterine adhesions. Hysterosalpingography and hysteroscopy are the ideal methods to make the diagnosis of IUA, and the latter is the safest, least traumatic, and most precise method of treating adhesions. The addition of an intrauterine splint and high-dose estrogen therapy completes the therapeutic approach. Before attempting conception the cavity should be inspected to verify its normality.

Abortion, Habitual↗
PubMed2006

Tort law and medical malpractice insurance premiums.

This paper estimated the effects of tort law and insurer investment returns on physician malpractice insurance premiums. Data were collected on tort law from 1991 through 2004, and multivariate regression models, including fixed effects for state and year, were used to estimate the effect of changes in tort law on medical malpractice premiums. The premium consequences of national policy changes were simulated. The analysis found that the introduction of a new damage cap lowered malpractice premiums for internal medicine, general surgery, and obstetrics/gynecology by 17.3%, 20.7%, and 25.5%, respectively. Lowering damage caps by dollar 100,000 reduced premiums by 4%. Statutes of repose also resulted in lower premiums. No other tort law changes had the effect of lowering premiums. Simulation results indicate that a national cap of dollar 250,000 on awards for noneconomic damages in all states would imply premium savings of dollar 16.9 billion. Extending a dollar 250,000 cap to all states that do not currently have them would save dollar 1.4 billion annually, or about 8% of the total. A negative effect on malpractice premiums was found for the Dow Jones industrial average, but not for bond prices; effects of the Nasdaq index were not significant for internal medicine, but were marginally significant for surgery and obstetrics premiums.

Economics, Medical↗
PubMed1991

Vasopressin and operative hysteroscopy in the management of delayed postabortion and postpartum bleeding.

Two women, one with refractory postabortion hemorrhage and the other with refractory postpartum hemorrhage, were managed with vasopressin, operative hysteroscopy, and a dilute vasopressin pack. Both patients had been treated by standard methods (i.e., dilation and curettage) and both were being prepared for a surgical intervention procedure. It was decided in both cases to try to slow the bleeding by injection of vasopressin paracervically and then performance of operative hysteroscopy. In both cases, the injection of dilute vasopressin paracervically when coupled with operative hysteroscopy was quite effective in determining the cause of the bleeding and was instrumental in avoiding major operative procedures.

Abortion, Induced↗
PubMed1964

MAYA MEDICINE.

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Central America↗
PubMed2006

A prospective randomized double-blind trial of the use of intrathecal fentanyl in patients undergoing lumbar spinal surgery.

STUDY DESIGN: A randomized, double-blind controlled study. OBJECTIVE: To assess the efficacy and safety of intrathecal fentanyl in the relief of postoperative pain in patients undergoing lumbar spinal surgery. SUMMARY OF BACKGROUND DATA: Fentanyl has been used as a spinal analgesic in surgery and obstetrics with several studies promoting its efficacy and safety. There is no evidence in the literature about intrathecal fentanyl in lumbar spinal surgery. Previous studies have looked at the use of intrathecal morphine and conclude that it is effective but also associated with respiratory depression. METHODS: Sixty patients undergoing posterior lumbar spine decompression with or without instrumented fusion were randomized to receive either 15 mug of fentanyl intrathecally under direct vision or nothing just before wound closure. After surgery, all patients received intravenous (IV) morphine via patient-controlled analgesia system (PCA) syringe driver. Outcome measures included visual analogue scores (VAS) for pain, time to first bolus of IV morphine PCA, and total amount of morphine PCA used. RESULTS: The patients who received fentanyl demonstrated a significant decrease in their mean pain VAS, an increase in the time to first PCA bolus, and a 41% reduction in the total PCA morphine received. No patients had respiratory compromise requiring treatment. There was no significant difference between the two groups with respect to age, gender, and case mix. CONCLUSION: Intrathecal fentanyl is effective at reducing pain and morphine PCA use after lumbar spinal surgery with minimal respiratory depression.

Adult↗
PubMedDate not supplied

[Women's health].

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Americas↗
PubMed1996

Rate of vertical transmission of HIV high in Black South Africans.

Although comparable with rates in other African countries, the "vertical transmission rate of HIV-1 for the Black population in Durban [South Africa] is high." The data was reported by Dr. Hoosen Coovadia and colleagues at the University of Natal Medical School in Durban. Coovadia followed HIV-1 positive women who gave birth at the King Edward VIII Hospital in Durban to estimate the rate of vertical transmission and the influence of various maternal risk factors on transmission rates. In the study cohort, which included 229 women and 181 infants, Coovadia observed a transmission rate of 34%, comparable with the estimated 20-45% reported in other regions of Africa. Women who had cesarean section deliveries were less likely to transmit HIV-1 to their infant. Although this association was previously reported by the European Collaborative study, Coovadia pointed out that it has not been reported in an African cohort before. While cesarean section delivery was protective against transmission, lower maternal hemoglobin levels were associated with an increased risk of transmission in this cohort. Coovadia added that "clearance of maternal antibodies is virtually achieved by 12 months of age and that this age could be used as a cutoff for the diagnosis of vertical infection in areas relying on antibody tests."

Adolescent↗