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difficult cesarean

Sergio Susmallian, Benjamin Raskin, Royi Barnea
INTRODUCTION: Retained surgical sponge or other items in patients' bodies happens more frequently than is reported. Healthcare personnel can forget to remove textile material or instruments during complicated, extended, or emergency surgery. In addition, changes in the operating team can influence the occurrence of such errors. PRESENTATION OF CASE: We present a case with a symptomatic gossypiboma nine years after a previous cesarean section. A 34-year-old woman was admitted to the emergency room having experienced abdominal pain and fever for the previous month...
October 14, 2016: International Journal of Surgery Case Reports
Kelsey L Shnaekel, Michael P Wendel, Nader Z Rabie, Everett F Magann
Objective: The aim of this review was to describe the risk factors, clinical and radiographic criteria, and management of this rare complication of pregnancy. Methods: A PubMed, Web of Science, and CINAHL search was undertaken with no limitations on the number of years searched. Results: There were 60 articles identified, with 53 articles being the basis of this review. Multiple risk factors have been suggested in the literature including retroverted uterus in the first trimester, deep sacral concavity with an overlying sacral promontory, endometriosis, previous abdominal or pelvic surgery, pelvic or uterine adhesions, ovarian cysts, leiomyomas, multifetal gestation, uterine anomalies, uterine prolapse, and uterine incarceration in a prior pregnancy...
October 2016: Obstetrical & Gynecological Survey
Ayaka Kawabe, Liangcheng Wang, Atsuko Kikugawa, Yuko Shibata, Kenichi Kuromaki, Akiyoshi Takagi
OBJECTIVE: Uterine rupture is a rare but serious obstetric complication. However, prediction and diagnosis at an early stage remain difficult. Herein, we report a case of primary uterine rupture found earlier by a specific symptom. CASE REPORT: A 29-year-old patient was scheduled to undergo a cesarean section (CS) due to placenta previa. However, at Week 35, she began experiencing abdominal pain and uterine contractions. Subsequently, she began experiencing severe pain, which was enhanced by fetal movements...
October 2016: Taiwanese Journal of Obstetrics & Gynecology
Ricardo F Sousa-Santos, Rui F Miguelote, Ricardo J Cruz-Correia, Cristina C Santos, João F M A L Bernardes
INTRODUCTION: Fetal growth charts are often used in clinical practice. It is important to understand the usefulness and the pitfalls associated with these tools. Without validation, it is difficult to ascertain if the cutoffs we intend are the ones we actually select. We developed a national standard for birthweight (BW) and compared it with other published reference values. STUDY DESIGN: Multicenter retrospective study. We collected data on live births, including first trimester ultrasound and pathology, from 23 to 42 weeks' gestational age (GA)...
September 29, 2016: European Journal of Obstetrics, Gynecology, and Reproductive Biology
Sung Hye Byun, So Young Lee, Seong Yeon Hong, Taeha Ryu, Baek Jin Kim, Jin Yong Jung
INTRODUCTION: In fetuses who are predicted to be at risk of catastrophic airway obstruction at delivery, the ex utero intrapartum treatment (EXIT) procedure is useful for securing the fetal airway while maintaining fetal oxygenation via placental circulation. Factors, including poor posture of the fetus and physician, narrow visual field, and issues of contamination in the aseptic surgical field, make fetal intubation during the EXIT procedure difficult. Herein, we report our experience of the usefulness of the GlideScope video laryngoscope (GVL) for intubation during the EXIT procedure...
September 2016: Medicine (Baltimore)
Yasushi Yamada, Satoshi Ohira, Teruyuki Yamazaki, Tanri Shiozawa
Ectopic molar pregnancy is extremely rare, and preoperative diagnosis is difficult. Our literature search found only one report of molar pregnancy diagnosed preoperatively. Moreover, there is no English literature depicting magnetic resonance image (MRI) findings of ectopic molar pregnancy. We report a case of ectopic molar pregnancy preoperatively diagnosed using MRI. A literature review of 31 cases of ectopic molar pregnancy demonstrated that lesions have been found in the fallopian tube (19 cases, 61%), ovary (5 cases, 16%), cornu (3 cases, 10%), peritoneum (2 cases, 6%), uterine cervix (1 case, 3%), and cesarean scar (1 case, 3%)...
2016: Case Reports in Obstetrics and Gynecology
Jila Agah, Roya Baghani, Yaser Tabaraei, Abolfazl Rad
Labor pain is one of the most tiresome types of pain. So human has been seeking to allay this pain until now. Administration of a suitable agent such as Entonox during labor is very beneficial for childbirth outcomes. Entonox can be administered in two ways: intermittently and continuously. The aim of this study is to demonstrate whether continuous method is as safe as intermittent method? This randomized clinical trial was performed in Mobini Hospital, Sabzevar, Iran. One hundred admitted women for vaginal delivery were included in this study...
2016: Iranian Journal of Pharmaceutical Research: IJPR
Nurullah Yilmaz, Ersin Koksal, Gokce Ultan Ozgen, Ersan Ozen, Ahmet Dilek, Deniz Karakaya, Fatma Ulger
We consider that general anesthesia will be an appropriate and safe method as regional methods could lead to significant time loss in the prevention or minimization of complications. High blockage required for regional anesthetic methods in pregnant women with TGA and the maintenance of hemodynamic stability may become difficult due to neuroaxial sympathectomy even if a successful neuroaxial block has been provided. Agents with minimal effect on cardiovascular functions should be preferred for anesthesia induction and maintenance and close hemodynamic monitoring should be done during intraoperative and postoperative periods...
June 2016: Medical Archives
Agnes M Lamon, Ashraf S Habib
Obesity is a worldwide epidemic. It is associated with increased comorbidities and increased maternal, fetal, and neonatal complications. The risk of cesarean delivery is also increased in obese parturients. Anesthetic management of the obese parturient is challenging and requires adequate planning. Therefore, those patients should be referred to antenatal anesthetic consultation. Anesthesia-related complications and maternal mortality are increased in this patient population. The risk of difficult intubation is increased in obese patients...
2016: Local and Regional Anesthesia
Dirk Wildemeersch, Norman D Goldstuck, Thomas Hasskamp
Immediate postpartum intrauterine device (IUD) insertion deserves great attention as it can provide immediate, timely and convenient contraception plus the added benefit of preventing repeat unintended pregnancies. Although women post vaginal delivery can benefit from immediate post-placenta contraception, women undergoing Cesarean section clearly need contraception, as an inter-delivery interval shorter than 18 months places them at a high risk for uterine rupture. The main drawback of currently available framed IUD devices for immediate postpartum insertion of an IUD is their high expulsion and displacement rates when inserted immediately postpartum after both vaginal and Cesarean delivery...
January 2016: Developmental Period Medicine
Ramesha Papanna, Stephen Fletcher, Kenneth J Moise, Lovepreet K Mann, Scheffer C G Tseng
BACKGROUND: There is an urgent need is for a regenerative patch for in utero repair of spina bifida in situations in which primary closure is difficult. CASES: We present two cases of large myeloschisis defects that underwent in utero spina bifida repair at midgestation with closure of the skin defect by using a cryopreserved human umbilical cord patch. The pregnancies were uncomplicated, and the births occurred at 37 weeks by planned cesarean delivery. The repair sites were intact with no evidence of cerebrospinal fluid leakage, with skin regenerated after delivery over a period of 3-4 weeks...
August 2016: Obstetrics and Gynecology
Laurent Zieleskiewicz, Anne Chantry, Gary Duclos, Aurelie Bourgoin, Alexandre Mignon, Catherine Deneux-Tharaux, Marc Leone
In developed countries, the rate of obstetric ICU admissions (admission during pregnancy or the postpartum period) is between 0.5 and 4 per 1000 deliveries and the overall case-fatality rate is about 2%. The most two common causes of obstetric ICU admissions concerned direct obstetric pathologies: obstetric hemorrhage and hypertensive disorders of pregnancy. This review summarized the principles of management of critically ill pregnant patient. Its imply taking care of two patients in the same time. A coordinated multidisciplinary team including intensivists, anesthesiologists, obstetricians, pediatricians and pharmacists is therefore necessary...
October 2016: Anaesthesia, Critical Care & Pain Medicine
Megan E Healy, Dana E Kozubal, Amanda E Horn, Gary M Vilke, Theodore C Chan, Jacob W Ufberg
BACKGROUND: Maternal resuscitation in the emergency department requires planning and special consideration of the physiologic changes of pregnancy. Perimortem cesarean delivery (PMCD) is a rare but potentially life-saving procedure for both mother and fetus. Emergency physicians should be aware of the procedure's indications and steps because it needs to be performed rapidly for the best possible outcomes. OBJECTIVE: We sought to review the approach to the critically ill pregnant patient in light of new expert guidelines, including indications for PMCD and procedural techniques...
August 2016: Journal of Emergency Medicine
Mun-Kun Hong, Tang-Yuan Chu, Dah-Ching Ding
OBJECTIVE: To proposed a novel method for a difficult laparoscopic hysterectomy that spares the cervical ligaments and eliminates the cervical canal and transformation zone of the cervix. CASE REPORT: A 40-year-old women, gravida 3 para 3, who had had a cesarean delivery previously, was referred to the gynecology clinic due to adenomyosis with menorrhagia and severe anemia. Ultrasonography showed that the uterus was enlarged to 13.5 cm × 10.7 cm × 8.8 cm...
June 2016: Taiwanese Journal of Obstetrics & Gynecology
Nicole Jastrow, Suzanne Demers, Nils Chaillet, Mario Girard, Robert J Gauthier, Jean-Charles Pasquier, Belkacem Abdous, Chantale Vachon-Marceau, Sylvie Marcoux, Olivier Irion, Normand Brassard, Michel Boulvain, Emmanuel Bujold
BACKGROUND: Choice of delivery route after previous cesarean delivery can be difficult because both trial of labor after cesarean delivery and elective repeat cesarean delivery are associated with risks. The major risk that is associated with trial of labor after cesarean delivery is uterine rupture that requires emergency laparotomy. OBJECTIVE: This study aimed to estimate the occurrence of uterine rupture during trial of labor after cesarean delivery when lower uterine segment thickness measurement is included in the decision-making process about the route of delivery...
June 21, 2016: American Journal of Obstetrics and Gynecology
Teresa Skelton, Isaac Nshimyumuremyi, Christian Mukwesi, Sara Whynot, Lauren Zolpys, Patricia Livingston
BACKGROUND: Safe anesthesia care is challenging in developing countries where there are shortages of personnel, drugs, equipment, and training. Anesthetists' Non-technical Skills (ANTS)-task management, team working, situation awareness, and decision making-are difficult to practice well in this context. Cesarean delivery is the most common surgical procedure in sub-Saharan Africa. This pilot study investigates whether a low-cost simulation model, with good psychological fidelity, can be used effectively to teach ANTS during cesarean delivery in Rwanda...
August 2016: Anesthesia and Analgesia
M Miccini, M Gregori, D Ferraro, A Ciardi, S Cassibba, D Biacchi
Abdominal scar endometriosis, corresponding to the presence of an endometrial tissue near or inside an abdominal surgical incision, is a rare clinical event that can occur in women after gynecological or obstetric surgery. Generally, a triad consisting of underlying mass at the incision, cyclic menstrual scar pain, and history of previous gynecological or obstetric surgery leads to the preoperative diagnosis. In rare cases, the clinical presentation is atypical and the differential diagnosis with incarcerated incisional hernia, granuloma, abscess or other soft tissue tumors can be difficult...
2016: Clinical and Experimental Obstetrics & Gynecology
Pei-Shen Huang, Bor-Ching Sheu, Su-Cheng Huang, Wen-Chun Chang
UNLABELLED: STUDY  OBJECTIVE: Intraligamental myomas (IMs) represent 6% to 10% of all uterine myomas. An IM growing from the lateral uterine wall into the broad ligament often presents as a large pelvic mass without symptoms. Removing a large IM can be difficult because of the limited operative field and poses challenges during conventional laparoscopic surgical approaches. The risk of injury to the ureter and uterine artery during myomectomy is greater than that during other types of myoma...
September 2016: Journal of Minimally Invasive Gynecology
Mohamed Mohamed Tawfik, Magdy Mamdouh Atallah, Walaa Safaa Elkharboutly, Nasser Sameh Allakkany, Mostafa Abdelkhalek
BACKGROUND: Preprocedural ultrasound may improve the efficacy and safety of epidural catheterization, especially in difficult cases. Most studies of ultrasound-assisted epidural catheterization in the obstetric population are dated and nonblinded with inconsistent designs. This double-blind, randomized controlled study aimed to compare the ultrasound-assisted with the conventional palpation techniques for epidural catheterization in parturients undergoing cesarean delivery. We hypothesized that the use of preprocedural ultrasound would increase the success rate of epidural catheterization at the first needle pass...
May 13, 2016: Anesthesia and Analgesia
Elizabeth M S Lange, Paloma Toledo, Jillian Stariha, Heather C Nixon
PURPOSE: The literature on the anesthetic management of parturients with dwarfism is sparse and limited to isolated case reports. Pregnancy complications associated with dwarfism include an increased risk of respiratory compromise, an increased risk of Cesarean delivery, and an unpredictable degree of anesthesia with neuraxial techniques. Therefore, we conducted this retrospective review to evaluate the anesthetic management of parturients with a diagnosis of dwarfism. METHODS: We used a query of billing data to identify short statured women who underwent a Cesarean delivery during May 1, 2008 to May 1, 2013...
August 2016: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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