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Acceptability of a urinary continence promotion programme to women in postpartum.

OBJECTIVE: To assess the acceptability to postpartum women of a physiotherapist-delivered urinary continence promotion programme. DESIGN: A survey of women participating in a randomised controlled trial where women received the intervention (which involved training in pelvic floor exercises and incorporated adherence-enhancing strategies) or usual postpartum care. SETTING: Postpartum wards of three tertiary teaching hospitals in the Hunter Region, NSW, Australia. SAMPLE: Women were eligible to participate in the trial if they had a forceps/ventouse assisted delivery and/or delivered a higher birthweight baby (> or =4000 g). This study is based primarily on data obtained for 348 women in the intervention group. METHODS: Baseline hospital-based interview; eight-week follow up appointment with physiotherapist; three-month follow up telephone interview. MAIN OUTCOME MEASURES: Comparative dropout rates for intervention and control groups; reasons for non-participation; attendance at hospital follow up; self-reported acceptability of and embarrassment about per vaginum examination; utilisation and perceived usefulness of intervention components; self-reported adherence with recommended pelvic floor exercise regime. RESULTS: There was no significant difference in dropouts between intervention (5.9%) and control groups (6.3%). Only 14% of women gave not wanting the per vaginum assessments as their main reason for not participating in the study. Eighty-eight percent of women participated in the eight-week postpartum follow up visit with the physiotherapist, with two-thirds of these women attending the hospital for this; 72.2% of women reported no embarrassment, and 22.5% just a little embarrassment about per vaginum assessment. The information components of the intervention were well received. At the eight-week follow up visit, 83.9% reported performing pelvic floor exercises at adequate frequency. CONCLUSIONS: The postpartum period provides an ideal opportunity for pelvic floor muscle testing and the delivery of continence promotion advice.

Adolescent↗

[Bilateral neonatal adrenal hemorrhage associated with hypoadrenalism].

A newborn is described, who was born in term with 3250 g weight, after intrauterine hypoxia. She was born with vacuum extraction, and suffered from birth trauma and intrauterine infection. At age of one day manifested an eclampsia, which was hardly diminishable. The serum Na level was 118 mmol/l. Bilateral adrenal apoplexy was visible with ultrasound. The newborn was treated with infusion of sodium chloride and glucose, with antibiotic and glucocorticoid hormone. Her condition improved rapidly. Her serum cortisol level at 8 and 15 day after stopping of 12 days prednisolon therapy was below 2.5 micrograms/dl, marking hypadrenia. At age 3 months the function of adrenals was normal: the serum cortisol level was 11.4 micrograms/dl, and after ACTH stimulation it run up to 44.5 micrograms/dl. By screening of 1491 newborns, 13 adrenal apoplexy was found. The other 12 were one-sided and symptomless.

Adrenal Glands↗

[Differential diagnosis of traumatic skull findings in infants: residues after vacuum extraction].

If autopsy findings in an infant show traumatic changes on the skullcap, these are not always the result of a postnatal trauma due to child abuse, a fall or another accidental event. With regard to differential diagnosis a birth trauma should also be kept in mind, so that the history of the delivery is important. The spectrum of possible residues after vacuum extraction (circular fracture and/or elevation of the outer table of skull bones, subperiostal and intraossal haematoma, extradural and subdural haemorrhage) is demonstrated by means of three examples from the forensic autopsy material.

Birth Injuries↗

Suction purpura.

BACKGROUND: Purpuric eruptions due to local mechanical causes are commonly seen, particularly in children. These eruptions are not always recognized as isolated purpura, and the patient may be submitted to an unnecessary extensive hematologic workup. We present various causes of suction purpura and outline a logical investigational approach. OBSERVATIONS: Suction purpura result from an external force exerting negative pressure on a circumscribed area of the skin, producing small grouped petechiae. We present a number of such suction purpura-causing mechanisms: Pressure during the delivery of a neonate, children's habits or play activities, and iatrogenic causes produce similar cutaneous lesions. We also describe the gas mask suction purpura for the first time. CONCLUSIONS: Once the causative factor is established, there is no need for further investigation or treatment of suction purpura. The lesions will fade completely within a few days.

Adolescent↗

Neonatal posterior fossa haemorrhage associated with vacuum extractor.

We report one case of posterior fossa intracranial haemorrhage in a full-term Malay baby boy following vacuum assisted delivery. The patient, a term baby boy was delivered by a vacuum extraction and later developed signs of increased intracranial pressure 72 hours after birth. Computed tomography (CT) of the brain showed a posterior fossa intracranial haemorrhage with acute obstructive hydrocephalus. He was initially treated with isolated ventricular shunting which later caused an upward cerebellar herniation. An immediate suboccipital craniectomy for evacuation of cerebellar haematoma was performed which resulted in a gradual recovery.

Adult↗

Transcatheter arterial embolization in the management of postpartum hemorrhage due to genital tract injury.

Six patients with uncontrollable postpartum hemorrhage due to genital tract injury were treated with transcatheter arterial embolization. The causes of hemorrhage were laceration of the cervix and vagina in five cases and rupture of the uterus in one. Four cases included a large hematoma in the paravaginal and/or retroperitoneal space. Two women had a hysterectomy before arterial embolization. Angiography revealed extravasation in five cases. All six subjects had their hemorrhage arrested dramatically using transcatheter arterial embolization with gelatin sponge particles. No major complication was encountered in any case. Normal menstruation resumed in the women who did not undergo a hysterectomy. Transcatheter arterial embolization therapy seems to be the treatment of choice in patients with uncontrollable hemorrhage.

Adult↗

[Induction of labor when a large fetus is suspected].

The courses of 945 deliveries in which the infant weighed greater than or equal to 3,800 g are reviewed retrospectively with comparison between the deliveries which began spontaneously and the induced deliveries. In the deliveries which were induced on account of a suspected large foetus, the frequency of emergency Cesarean section was tripled and the frequency of vacuum extraction was doubled. Significantly more infants had Apgar scores of less than 7 after one minute than in the deliveries which began spontaneously. It is concluded that induction of labour is not indicated in cases where a large foetus is suspected.

Birth Weight↗

Uterine perforation during second-trimester abortion by cervical dilation and instrumental extraction: a review of 15 cases.

Review of the records of 15 women who had uterine perforations at the time of second-trimester abortion by dilation and evacuation showed that unexpected pain (but not excessive bleeding) was the most prominent sign. All patients required laparotomy, but in no case was laparotomy necessary as an emergency procedure. Laparoscopy was not helpful. Two-thirds had bowel injuries and two required hysterectomy. Errors in estimating gestational duration, inadequate cervical dilation, and failure to use sonography characterized these complicated cases.

Abortion, Induced↗

[Value of RU 486 in failed terminations of pregnancy].

One of the complications of therapeutic termination of pregnancy is the complete retention of the embryo. The authors present four cases of repeated failure to evacuate the uterus associated with multiple fibroids or a malformation of the uterus. The use of RU 486 to soften the cervix and to allow it to dilate spontaneously made it possible in each case to aspirate the products completely. This action on the cervix of RU 486 could be used to make it easier to terminate early pregnancies up to the 12th week and particularly when there is associated uterine pathology.

Abortifacient Agents↗

[Pregnancy and delivery after renal transplantation (author's transl)].

A case report is given on a 21-years-old woman who became pregnant 18 months after renal transplantation. In spite of relatively unfavourable conditions (match 0,25; hypertension) renal function showed a good adaptation throughout the gestation. In the 38. week of pregnancy the woman was successfully delivered of a 2440 g healthy female child by vacuum extraction. There were no effects of the immunsuppressive drugs on the newborn. It is the third case of a successful delivery after renal transplantation in the GDR.

Adult↗