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James Young Simpson: the controversy surrounding the presentation of his Air Tractor (1848-1849).
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Neonatal subgaleal hematoma causing brain compression: report of two cases and review of the literature.
OBJECTIVE AND IMPORTANCE: Neonatal subgaleal hematomas (SGHs) are infrequent but underdiagnosed collections of blood beneath the galea, often caused by vacuum delivery. With massive bleeding into the subgaleal space, exsanguination and hypovolemic shock can cause death in 20 to 60% of newborn infants. We report the first two known patients with extracranial cerebral compression caused by SGH. Also, the surgical evacuation of neonatal SGH has not been described previously. CLINICAL PRESENTATION: One patient was a full-term boy who was delivered via vacuum extraction after an uncomplicated pregnancy. Within a few hours, he developed an expanding fluid collection of the scalp and disseminated intravascular coagulation and shock requiring intubation, inotropic support, and blood transfusions. His head circumference grew from 33 cm at birth to 42 cm. He became progressively lethargic and developed posturing movements. Computed tomography of the head revealed a massive SGH causing gross overlapping of the cranial sutures and diffuse cerebral edema. The other patient was a full-term boy delivered via cesarean section after an unsuccessful attempt at vacuum extraction and forceps delivery. The initial head circumference was 34 cm. Within a few hours, he developed an expanding fluid collection of the scalp and became progressively lethargic with posturing. Magnetic resonance imaging of the head revealed a massive SGH with cranial compromise and diffuse cerebral edema. INTERVENTION: Both children had radiographic features indicative of elevated intracranial pressure as well as neurological decompensation. The first patient was taken to the operating room, and the hematoma was evacuated through a small scalp incision. Initially, approximately 150 ml of blood was removed, and a Jackson-Pratt drain diverted another 200 ml of blood during the next 2 days. The infant made a good recovery. In the second case, the patient remained too unstable for operative intervention and died. CONCLUSION: Extracranial cerebral compression represents another way by which neonatal SGH may jeopardize the infant's life. Management consists of measures to correct hypovolemic shock and disseminated intravascular coagulation, as well as surgical intervention to control elevated intracranial pressure.
Delivery following colon interposition.
BACKGROUND: Colon interposition carries a significant complication rate due to attenuated arterial blood supply, because the interposed colon segment depends on a single vascular pedicle. CASES: We report for the first time five vaginal deliveries in two women following the operation, illustrating the dilemmas encountered in choosing the delivery method in these patients. CONCLUSION: We suggest that vaginal delivery following colon interposition is feasible. If cesarean section has to be performed, extra care must be exercised not to damage the vascular pedicle, particularly when there is a need for mobilizing or palpating the posterior aspect of the uterus.
Preinductive cervical ripening with prostaglandin E2 in women with one previous cesarean section.
Thirty term pregnant women with one previous cesarean section and with unripe cervices were given 0.5 mg prostaglandin E2 in gel strictly intracervically for cervical ripening and labor induction. Fifteen out of these 30 women (50%) were vaginally delivered within 24 hours. The cervical ripening/labor induction was considered a failure in two women. In one woman, an episode of hypercontractility was registered. After tocolytic therapy the uterine activity was normalised and the woman had a normal vaginal delivery. The frequency of cesarean sections was 8/30 (27%). At the operations no insufficiencies in the uterine scars were noted. Conclusively, strict intracervical application of 0.5 mg prostaglandin E2 in gel can be used for cervical ripening and labor induction also in women with one previous cesarean section.
Successful outcome in a pregnancy complicated by large hepatic hemangioma.
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Removing rectal foreign bodies: is the ventouse gender specific?
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[Surgical treatment of habitual abortion].
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[Prevention of birth injuries].
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Loss prevention case of the month. Learn from and respond to the record.
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Bleeding patterns after early abortion with mifepristone and misoprostol or manual vacuum aspiration.
OBJECTIVE: To prospectively determine patterns and predictors of bleeding after early abortion with mifepristone and misoprostol or manual vacuum aspiration (MVA). METHODS: Women fewer than 63 days from the last menstrual period and desiring termination of pregnancy were offered medical abortion with 200 mg oral mifepristone and 800 micrograms oral misoprostol or MVA under local anesthesia. Women completed a bleeding diary during the six weeks after abortion. Telephone calls were used to encourage diary completion and determine contraception use. RESULTS: 212 women were enrolled, 80% of whom completed diaries. Mean days of bleeding was higher in the medical (14 days) than MVA (9 days) group, but days of spotting (about 10) was similar in both groups. Increasing gestational age predicted more bleeding or spotting days after medical, but not MVA, abortion. Prolonged bleeding was not rare and was more common in the medical than the surgical abortion group. Combined oral contraceptive (COC) users and non-COC users had similar bleeding patterns after medical or surgical abortion. CONCLUSION: Bleeding after early medical abortion persists longer than after MVA and continues longer than previously appreciated regardless of method. Oral contraceptive use does not decrease bleeding after early medical or surgical abortion.
Vesicouterine fistula after vacuum delivery and two previous cesarean sections. A case report.
BACKGROUND: Vesicouterine fistulas are associated with cesarean section and more rarely with vaginal birth after cesarean (VBAC). Many surgical approaches exist, including hysterectomy. CASE: A vesicouterine fistula was diagnosed after VBAC in a 34-year-old multipara with two previous cesarean sections. The defect failed to close after four months of bladder drainage. Closure via laparotomy with an omental flap and preservation of the uterus was successful. CONCLUSION: Vesicouterine fistula can occur after VBAC, and failure of conservative therapy can be treated abdominally with preservation of the uterus.
[High vacuum extraction: justifiably obsolete in view of the risks to the infant].
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[High vacuum extraction: justifiably obsolete taking into account the risks for the child].
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[Gestation in patients with heart disease].
A brief report of the special management of pregnant women suffering from heart-disease has been given. There were 188 (0,72%) of all together 26233 deliveries in 170 women with heart-failure. Cesarean section by cardiological indications as a matter of course will be carried out only in few special cases. The management tends to vaginal delivery with shortening the last period by operating. In comparison with the period from 1946 to 1962 the mortality of the mothers decreased from 7,8% to 0,5% the mortality of the infants from 9,8% to 3,2% and the prematurity by weight from 25,5% to 8,5%.
[Report on a case of simultaneous extra- and intrauterine pregnancy with delivery of a healthy infant].
Report on the occurrence of a simultaneous intra- and extrauterine pregnancy. The extrauterine pregnancy was operated during its sixth week. At the time of the operation the intrauterine pregnancy was not recognized. The enlargement of the uterus was regarded as con sensual. Only during the check-up which took place four weeks after the patient's discharge from the hospital the intrauterine pregnancy was diagnosed. Three weeks before term a healthy infant was born by means of vacuum.
Reappraisal of neonatal clavicular fracture. Relationship between infant size and risk factors.
OBJECTIVE: To examine the role of fetal size in neonatal clavicular fracture. STUDY DESIGN: A retrospective, case-control study was performed on infants diagnosed with neonatal clavicular fractures and born vaginally between July 1997 and June 2000. For each index case, a control matched for gestational age (within one week) and birth weight (within 250 g) and delivered within the same 24-hour period was selected at random from the delivery suite registry. The maternal and intrapartum factors were compared and the results analyzed according to whether the infants were large for gestational age (LGA) or not. RESULTS: Among 9,540 neonates delivered vaginally during this period, 151 (1.6%) had a fractured clavicle. Multivariate analysis indicated that the independent risk factors were shoulder dystocia and vacuum extraction. When analyzed according to fetal size, shoulder dystocia was significant only for LGA infants, while vacuum extraction was significant only for non-LGA infants. CONCLUSION: Independent risk factors for neonatal clavicular fracture are related to fetal size.
[Life-threatening subgaleal bleeding in a newborn infant].
Subgaleal haematoma, also called subaponeurotic haemorrhage, is a serious but rarely seen form of bleeding that can occur as a complication to vacuum-assisted delivery. Subgaleal haemorrhage may be much more copious than the more common subperiostal bleeding, and can almost exsanguinate the infant. A pressure bandage applied to the upper head can be lifesaving.