Cesarean section and simultaneous hernia repair.

HYPOTHESIS: The combination of cesarean section with inguinal or umbilical hernia repair is safe, effective, and well-accepted compared with cesarean section alone. DESIGN: Retrospective comparative study. SETTING: Tertiary care university hospital. PATIENTS: Eight patients undergoing cesarean section combined with hernia repair (inguinal in 5 and umbilical in 3) vs 305 low-risk patients undergoing cesarean section alone. MAIN OUTCOME MEASURES: Operation time, blood loss, opiate use, peripartum complications, hospital stay, hernia recurrence, and patient impression. RESULTS: The combined procedure took significantly longer than cesarean section alone in the case of inguinal but not umbilical hernia. There were no major complications. Wound healing was delayed, without infection, in 1 patient with an inguinal hernia. Blood loss, opiate use, and hospital stay did not differ significantly from those of controls. No hernia recurred after a mean observation period of 56 months. Seven of the 8 patients reported that they would recommend the combined operation. CONCLUSIONS: Combined cesarean section and hernia repair avoids rehospitalization for separate hernia repair. With a single incision (in the case of inguinal hernia repair), single anesthesia, and single hospital stay, the combined procedure confers valuable advantages for both patient and hospital in time, cost, and convenience, not to mention avoiding the separation of mother from newborn entailed by reoperation. Our results in a pilot group indicate that the combination approach is safe, effective, and well accepted. Confirmation in a larger population should establish it as a recommendable procedure.

Quantification of fetomaternal hemorrhage by fluorescence microscopy is equivalent to flow cytometry.

BACKGROUND: The quantification of fetal cells in the maternal circulation remains an important goal to determine the amount of anti-D necessary to prevent active immunization of a D- mother giving birth to a D+ baby. Underestimation of fetomaternal hemorrhage (FMH) results in inefficient anti-D prophylaxis and maternal immunization; overestimation of FMH results in higher doses of passively transferred anti-D, higher costs, and the risk of disease transmission. Thus, a reliable method to quantitatively assess FMH is necessary. STUDY DESIGN AND METHODS: Serial dilutions of artificial FMH were quantitatively measured by three different methods: flow cytometry, fluorescence microscopy (each after anti-D staining), and by the Kleihauer-Betke test. The accuracy and precision of the three methods were compared by statistical analysis. RESULTS: Fluorescence microscopy and flow cytometry were comparably accurate and precise in quantifying FMH. In contrast, the accuracy of the Kleihauer-Betke test was poor, resulting in substantial overestimation of FMH in the samples with lower fetal cell concentrations. CONCLUSION: Anti-D flow cytometry and fluorescence microscopy for detection of fetal cells offer equally reliable and precise methods in contrast to the Kleihauer-Betke test. Fluorescence microscopy may be established as standard to quantify FMH in clinical practice because it is comparable to flow cytometry; in addition, it is time saving and is less expensive.