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At least 721 records · Page 40Linked to original sources
PubMed2004

Development of the human fetal pons: in utero ultrasonographic study.

OBJECTIVES: To examine the ultrasonographic feasibility of imaging the fetal pons and to construct a reference chart for its normal development during gestation. METHODS: A cross-sectional, prospective study on 293 healthy fetuses of low-risk pregnancies between 19 and 34 weeks was performed. The transfontanel approach, via the abdominal or vaginal routes, was used to evaluate the fetal metencephalon (pons and cerebellum). The anteroposterior diameter of the fetal pons was measured in a mid-sagittal plane. The longitudinal diameter of the cerebellar vermis was measured at the same plane and the vermis-pons ratio (VPR) was established. RESULTS: One hundred and forty-four fetuses were in vertex position. In 140 (97.2%) satisfactory visualization and measurements of the pons and cerebellar vermis were obtained. One hundred and forty-nine fetuses were breech presentations and measurements were successfully performed in 147 (98.6%). The pons anteroposterior and vermis longitudinal diameters showed a linear correlation with gestational age (GA) (r = 0.95 for both measurements; P < 0.001). The mean VPR was 1.5 (+/-0.1 SD) and did not change in the gestational interval that was considered. CONCLUSION: By using the transfontanel approach, evaluation of the fetal pons is feasible via the mid-sagittal plane. The nomograms developed and the ratio to fetal vermis provides reference data that may be helpful when evaluating anomalies of the brainstem.

Cross-Sectional Studies↗
PubMed1994

A multicenter review of 839 laparoscopic-assisted vaginal hysterectomies.

A multicenter review of 839 cases of laparoscopic-assisted vaginal hysterectomy (LAVH) was conducted to contribute to the clinical decision-making process regarding the procedure, which has been the subject of much debate in recent years. The results suggest that patients undergoing LAVH experience complication rates no higher than those having any other type of hysterectomy, and that efficacy is identical to that of vaginal hysterectomy. Furthermore, the laparoscopic approach affords better visualization of pelvic pathology and better adnexal access for the accomplishment of concurrent pelvic procedures. Mean hospital stay is 1.7 days and mean recovery time 20 days. The notion of a learning curve as described by diminishing procedure time and declining complication rates over time is not supported by this data set. Patients who may traditionally have faced abdominal hysterectomy due to putative or demonstrated pelvic pathology may benefit the most from LAVH.

Adult↗
PubMed2000

[Congenital vaginal aplasia: laparoscopic reconstruction of a neovagina using the Vecchietti technique in the Mayer-von Rokitansky-Kuester-Hauser syndrome].

OBJECTIVE: Creation of a neovagina in patients with congenital vaginal aplasia and evaluation of laparoscopic approach. DESIGN: Pilot prospective. SETTING: Department of Gynaecology and Minimally Invasive Surgery Hospital Na Homolce. METHODS: Four patients with the above mentioned syndrome were included and the laparoscopic modification of the open Vecchietti's technique was used. All patients had a complete clinical examination and ultrasound evaluation. RESULTS: No complications were found. The mean duration of surgery was 96 min. After two weeks a satisfactory vaginal length was achieved in all patients. SUMMARY: The laparoscopic approach has all advantages of minimally invasive surgery. At the same time the advantages of Vecchietti's open technique are maintained.

Female↗
PubMed1981

[Technique of transvaginal operation of Stein-Leventhal-syndrome (author's transl)].

Transvaginal surgery for Stein-Leventhal syndrome is introduced in this paper. The following advantages are claimed for the new approach, as compared to abdominal surgery: less time required for surgical intervention, no laparotomic scar, smaller peritoneal wound, less traumatisation. The surgeon in command of vaginal surgery will find the new approach more convenient than the abdominal route.

Female↗
PubMed2006

Tension-free transobturator tape procedure for stress urinary incontinence.

PURPOSE OF REVIEW: Recent data on the tension-free transobturator tape procedure for the treatment of female stress urinary incontinence are reviewed. RECENT FINDINGS: Although long-term data are not available, the effectiveness and safety of the tension-free transobturator tape procedure as reported during the past 5 years are very promising and this procedure is becoming a popular surgical treatment for female stress urinary incontinence. The continence rates obtained have been similar to those obtained using the retropubic tension-free vaginal tape on short-term follow-up. Clinical data as well as studies on cadaveric dissections suggest that complication rates can be decreased significantly with the transobturator approach. In the original tension-free transobturator tape procedure, the tape is inserted through the obturator foramen from the outside-to-inside direction (skin incision to vaginal incision). The inside-to-outside approach with passage of the tape from the vaginal incision to the obturator foramen has also been described. SUMMARY: The tension-free transobturator tape procedure provides a useful alternative to the retropubic tension-free vaginal tape approach while maintaining the principles of tension-free midurethral support. By avoiding the intrapelvic and retropubic passage, complications can be decreased. The effectiveness of this approach is similar to that of tension-free vaginal tape on short-term follow-up.

Female↗
PubMed1995

[Diagnostic reliability of vaginal ultrasound in ectopic pregnancy].

The therapeutic approach to ectopic pregnancy (EP) has changed over the last decade. A prerequisite for a differentiated management is an early diagnosis of EP. This can be achieved by transvaginal sonography (TVS). The purpose of this study was to evaluate the accuracy of TVS in the diagnosis of EP. 184 patients with clinically suspected ectopic pregnancy were examined by TVS. In 103 cases suspicion of EP was confirmed, in 81 cases it was ruled out. All cases were evaluated by laparoscopy, D&C, serial HCG determinations or sonographic follow-up in case of an intrauterine pregnancy. Sensitivity of TVS in the diagnosis of EP was 96%, specificity 88%, the positive predictive value was 89%, the negative predictive value was 95%. Four cases with a false negative result at TVS were very early in pregnancy and were subjected to laparoscopy because of persistent high HCG values without demonstration of an intrauterine pregnancy. Five cases of sonographically confirmed ectopic pregnancies were missed by the first laparoscopy. These cases required intervention because of clinical symptoms and had low levels of HCG. TVS has a high diagnostic accuracy in the diagnosis of ectopic pregnancy.

Adolescent↗
PubMed1976

Vaginal hysterectomy by an anterior colpotomy technic.

A simple, relatively unknown technic of vaginal hysterectomy using the anterior colpotomy approach is presented. Experience with this procedure at a small Naval hospital is described. Morbidity occurred in 6.6% of the patients. The advantages of this method of vaginal hysterectomy are summarized.

Adult↗
PubMed2000

Transvaginal repair of postcystectomy peritoneovaginal fistulae.

To our knowledge, peritoneovaginal fistula is a complication of cystectomy that has not been reported before. We describe 2 patients in whom a transvaginal approach using a Martius flap was utilized to repair persistent vaginal leakage after cystectomy. At a mean follow-up of 20 months, both patients are free from vaginal leakage and have no evidence of recurrent fistula. This approach offers a safe and effective way to repair a peritoneovaginal fistula in a cystectomy patient.

Cystectomy↗
PubMed2005

Surgical approach to hysterectomy for benign gynaecological disease.

BACKGROUND: There are three approaches to hysterectomy for benign disease - abdominal hysterectomy (AH), vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH). Laparoscopic hysterectomy has three further subdivisions - laparoscopic assisted vaginal hysterectomy (LAVH) where a vaginal hysterectomy is assisted by laparoscopic procedures that do not include uterine artery ligation, laparoscopic hysterectomy (which we will abbreviate to LH(a)) where the laparoscopic procedures include uterine artery ligation, and total laparoscopic hysterectomy (TLH) where there is no vaginal component and the vaginal vault is sutured laparoscopically. OBJECTIVES: To assess the most appropriate surgical approach to hysterectomy. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders & Subfertility Group's Specialised Register of controlled trials (searched 23 March 2004), CENTRAL (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to Mar 2004), EMBASE (1985 to Mar 2004), Biological Abstracts (1968 to Mar 2004), the National Research Register and relevant citation lists. SELECTION CRITERIA: Only randomised trials comparing one surgical approach to hysterectomy with another were included. DATA COLLECTION AND ANALYSIS: Twenty-seven trials that included 3643 participants were included. Independent selection of trials and data extraction were employed following Cochrane guidelines. MAIN RESULTS: The benefits of VH versus AH were shorter duration of hospital stay (WMD 1.0 day, 95%CI 0.7 to 1.2 days), speedier return to normal activities (WMD 9.5 days, 95%CI 6.4 to 12.6 days), fewer unspecified infections or febrile episodes (OR 0.42, 95%CI 0.21 to 0.83). The benefits of LH versus AH were lower intraoperative bloodloss (WMD 45.3 mls, 95%CI 17.9 to 72.7 mls) and a smaller drop in haemoglobin level (WMD 0.55g/L, 95%CI 0.28 to 0.82g/L), shorter duration of hospital stay (WMD 2.0 days, 95%CI 1.9 to 2.2 days), speedier return to normal activities (WMD 13.6 days, 95%CI 11.8 to 15.4 days), fewer wound or abdominal wall infections (OR 0.32, 95%CI 0.12 to 0.85), fewer unspecified infections or febrile episodes (OR 0.65, 95%CI 0.49 to 0.87), at the cost of longer operating time (WMD 10.6 minutes, 95%CI 7.4 to 13.8 minutes) and more urinary tract (bladder or ureter) injuries (OR 2.61, 95%CI 1.22 to 5.60). There was no evidence of benefits of LH versus VH and the operating time was increased (WMD 41.5 minutes, 95%CI 33.7 to 49.4 minutes). There was no evidence of benefits of LH(a) versus LAVH and the operating time was increased for LH(a) (WMD 25.3 minutes, 95%CI 10.0 to 40.6 minutes). There was statistical heterogeneity in many of the outcome measures when randomised trials were pooled for meta-analysis. No other statistically significant differences were found. However, for some important outcomes, the analyses were underpowered to detect important differences, or they were simply not reported in trials. Data were notably absent for many important long-term outcome measures. AUTHORS' CONCLUSIONS: Significantly improved outcomes suggest VH should be performed in preference to AH where possible. Where VH is not possible, LH may avoid the need for AH, however the length of the surgery increases as the extent of the surgery performed laparoscopically increases, particularly when the uterine arteries are divided laparoscopically and laparoscopic approaches require greater surgical expertise. The surgical approach to hysterectomy should be decided by a woman in discussion with her surgeon in light of the relative benefits and hazards. Further research is required with full reporting of all relevant outcomes, particularly important long-term outcomes, in large RCTs, to minimise the possibility of reporting bias. Further research is also required to define the role of the newer approaches to hysterectomy such as TLH.

Female↗
PubMed2006

Surgical approach to hysterectomy for benign gynaecological disease.

BACKGROUND: There are three approaches to hysterectomy for benign disease - abdominal hysterectomy (AH), vaginal hysterectomy (VH) and laparoscopic hysterectomy (LH). Laparoscopic hysterectomy has three further subdivisions - laparoscopic assisted vaginal hysterectomy (LAVH) where a vaginal hysterectomy is assisted by laparoscopic procedures that do not include uterine artery ligation, laparoscopic hysterectomy (which we will abbreviate to LH(a)) where the laparoscopic procedures include uterine artery ligation, and total laparoscopic hysterectomy (TLH) where there is no vaginal component and the vaginal vault is sutured laparoscopically. OBJECTIVES: To assess the most appropriate surgical approach to hysterectomy. SEARCH STRATEGY: We searched the Cochrane Menstrual Disorders & Subfertility Group's Specialised Register of controlled trials (searched 23 March 2004), CENTRAL (The Cochrane Library Issue 1, 2004), MEDLINE (1966 to Mar 2004), EMBASE (1985 to Mar 2004), Biological Abstracts (1968 to Mar 2004), the National Research Register and relevant citation lists. SELECTION CRITERIA: Only randomised trials comparing one surgical approach to hysterectomy with another were included. DATA COLLECTION AND ANALYSIS: Twenty-seven trials that included 3643 participants were included. Independent selection of trials and data extraction were employed following Cochrane guidelines. MAIN RESULTS: The benefits of VH versus AH were shorter duration of hospital stay (WMD 1.0 day, 95%CI 0.7 to 1.2 days), speedier return to normal activities (WMD 9.5 days, 95%CI 6.4 to 12.6 days), fewer unspecified infections or febrile episodes (OR 0.42, 95%CI 0.21 to 0.83). The benefits of LH versus AH were lower intraoperative bloodloss (WMD 45.3 mls, 95%CI 17.9 to 72.7 mls) and a smaller drop in haemoglobin level (WMD 0.55g/L, 95%CI 0.28 to 0.82g/L), shorter duration of hospital stay (WMD 2.0 days, 95%CI 1.9 to 2.2 days), speedier return to normal activities (WMD 13.6 days, 95%CI 11.8 to 15.4 days), fewer wound or abdominal wall infections (OR 0.32, 95%CI 0.12 to 0.85), fewer unspecified infections or febrile episodes (OR 0.65, 95%CI 0.49 to 0.87), at the cost of longer operating time (WMD 10.6 minutes, 95%CI 7.4 to 13.8 minutes) and more urinary tract (bladder or ureter) injuries (OR 2.61, 95%CI 1.22 to 5.60). There was no evidence of benefits of LH versus VH and the operating time was increased (WMD 41.5 minutes, 95%CI 33.7 to 49.4 minutes). There was no evidence of benefits of LH(a) versus LAVH and the operating time was increased for LH(a) (WMD 25.3 minutes, 95%CI 10.0 to 40.6 minutes). There was statistical heterogeneity in many of the outcome measures when randomised trials were pooled for meta-analysis. No other statistically significant differences were found. However, for some important outcomes, the analyses were underpowered to detect important differences, or they were simply not reported in trials. Data were notably absent for many important long-term outcome measures. AUTHORS' CONCLUSIONS: Significantly improved outcomes suggest VH should be performed in preference to AH where possible. Where VH is not possible, LH may avoid the need for AH, however the length of the surgery increases as the extent of the surgery performed laparoscopically increases, particularly when the uterine arteries are divided laparoscopically and laparoscopic approaches require greater surgical expertise. The surgical approach to hysterectomy should be decided by a woman in discussion with her surgeon in light of the relative benefits and hazards. Further research is required with full reporting of all relevant outcomes, particularly important long-term outcomes, in large RCTs, to minimise the possibility of reporting bias. Further research is also required to define the role of the newer approaches to hysterectomy such as TLH.

Female↗
PubMed2005

Outcomes of labours augmented with oxytocin.

OBJECTIVE: To highlight the differences in mode of delivery between women augmented with intravenous oxytocin because of failure to progress in labour with those who labour without the need for augmentation. STUDY DESIGN: An incidence study over a 5-year-period in a tertiary referral hospital comparing 1097 nulliparous women who were augmented in labour with 2745 nulliparous women who did not need augmentation. Only labours of spontaneous onset in the pregnancies of women at term were studied. The incidence of pregnancy outcomes were assessed by presenting estimates of relative risk (RR) and their 95% confidence intervals (CI). RESULTS: Only 51.1% of women who received augmentation achieved a normal vaginal delivery compared with 76.5% of women who did not need augmentation (RR 0.67; CI 0.63-0.71). Contributory factors to this disparity included a greater number of Caesarean sections (14.4% versus 6.6%; RR 2.18 CI 1.74-2.67), forcep deliveries (12.8% versus 5.3%; RR 2.41 CI 1.93-3.01) and ventouse deliveries (21.7% versus 11.5%; RR 1.89 CI 1.62-2.21) being performed among augmented labours as compared to normal progressive labours. CONCLUSION: Significant improvements in the management of labours which fail to progress are needed if normal vaginal delivery rates are to approach those seen in labours which progress without the need for augmentation.

Adult↗
PubMed1998

Potential consequences of widespread antepartal use of ampicillin.

OBJECTIVE: Recommendations for the use of antenatal antibiotics in obstetrics have increased in the past few years, especially for prophylaxis against group B streptococci, for prolongation of the latency time in patients with preterm premature rupture of the membranes, and as an adjuvant treatment in preterm labor. Our objective was to determine whether the use of antenatal ampicillin affects the incidence of and resistance of early-onset neonatal sepsis with organisms other than group B streptococci. STUDY DESIGN: A prospective cohort study was performed between January 1, 1991, and December 31, 1996. Every case of blood culture-proven neonatal sepsis was prospectively surveyed. The type of bacteria isolated, drug resistance, antenatal antibiotic use and treatment indication, gestational age at delivery, and other antenatal and outcome variables were gathered. Early-onset neonatal sepsis was defined as disease onset within 7 days after birth. RESULTS: A total of 42 cases of early-onset neonatal sepsis among 29,897 neonates delivered were found during the 6-year period. Of these, 15 cases were due to group B streptococci and 27 were the result of non-group B streptococcal organisms (21 gram-negative rods and 6 gram-positive cocci). Among the 27 non-group B streptococcal cases, 15 mothers had received antenatal ampicillin and 13 of the 15 bacterial isolates from these neonates (87%) were resistant to ampicillin, versus only 2 ampicillin-resistant isolates (17%) among the 12 cases in which no antenatal antibiotics were administered (P = .0004). Of the 15 mothers who were treated with ampicillin, 13 received more than 1 dose. In evaluating each year of the study, the overall administration of antibiotics to pregnant women in the antenatal period increased from <10% in 1991 to 16.9% in 1996. The incidence of early-onset neonatal sepsis with group B streptococci decreased during this time, whereas the incidence of early-onset sepsis with non-group B streptococcal organisms, especially Escherichia coli, increased. CONCLUSIONS: The increased administration of antenatal ampicillin to pregnant women may be responsible for the increased incidence of early-onset neonatal sepsis with non-group B streptococcal organisms that are resistant to ampicillin. At this time penicillin G, rather than ampicillin, is therefore recommended for prophylaxis against group B streptococci. In addition, future studies are needed to determine whether alternate approaches, such as immunotherapy or vaginal washing, could be of benefit.

Ampicillin↗
PubMed1977

Development of anaerobic fecal flora in healthy newborn infants.

Stool samples from 196 healthy infants less than ten days of age were cultured to delineate bacterial colonization patterns of the intestine. By one week of age, isolation rates of Bacteroides fragilis and other anaerobic bacteria in term infants following vaginal delivery and formula feeding approach that of adults. Differences in gestational age, type of delivery, and type of feeding are associated with significantly different colonization patterns of anaerobic and aerobic bacteria in the first week after birth.

Anaerobiosis↗
PubMedDate not supplied

Antenatal and perinatal strategies to prevent mother-to-child transmission of HIV infection.

Mother-to-child transmission (MTCT) is the dominant mode of acquisition of HIV infection for children. Each day an estimated 1600 children born to HIV-infected mothers become infected, 1500 of whom are in sub-Saharan Africa. Mother-to-child transmission can occur before, during and after delivery; overall rates of MTCT range from 15 to 35%. Risk factors for MTCT include maternal viral load levels, vaginal delivery, prematurity and breastfeeding. Approaches to reduce the risk of MTCT include reduction of maternal viral load through antiretroviral prophylaxis, avoidance of exposure through birth canal cleansing or elective caesarean section delivery and refraining from breastfeeding, and boosting the host immune system through nutritional supplementation or immunization. Substantial reductions in the risk of MTCT can be achieved with antiretroviral prophylaxis during pregnancy, delivery and in the neonatal period, both in settings with and without breastfeeding. Elective caesarean section independently decreases the risk, but is not a safe and feasible option in most high prevalence areas. Birth canal cleansing with chlorhexidine does not reduce the rate overall, but may be beneficial in a subgroup of women with prolonged duration of ruptured membranes. Micronutrient supplementation, including vitamin A, does not reduce MTCT of HIV, but may improve pregnancy outcome generally.

Anti-HIV Agents↗
PubMed1999

Active management of labor.

The active management of labor may be one approach to achieving lower rates of intervention. Numerous institutions have reported lower CS rates since initiating this labor management scheme, and concurrent decreases in the length of labor and infectious morbidity have been demonstrated. Sufficient data now exist to conclude that such programs can be instituted without deleterious effects on neonatal outcomes. Nevertheless, success in decreasing CS rates has not been uniform and may be confined to certain settings. Other approaches to labor management may be as good or better at achieving low rates of intervention with minimum morbidity. Any approach that emphasizes advocacy for vaginal birth is likely to produce some success and should receive support.

Cesarean Section↗
PubMed1998

Hysterectomy and myomectomy by laparotomy.

Hysterectomy provides definitive treatment for uterine fibroids. Surgery should be offered to women whose fibroids are symptomatic; it is not indicated on the basis of uterine size alone. Myomectomy is an option for those wishing to preserve uterine function. The prospects for successful pregnancy following myomectomy are encouraging, although there is a significant risk of the later recurrence of fibroids. Laparotomy remains the most appropriate surgical approach for large fibroids, although vaginal, rather than abdominal, hysterectomy may be suitable for some women whose uteri do not exceed a 12-14 week gestation size. There is some evidence that the morbidity of abdominal procedures increases with very large uteri. Uterine shrinkage with GnRH analogues may facilitate vaginal hysterectomy and be useful prior to abdominal hysterectomy or myomectomy for very large fibroids, although cost-effectiveness for its use with abdominal procedures has not been demonstrated.

Female↗