الملخص
In the past decade, the rate of cesarean sections has doubled leading to the more frequent occurrence of cesarean-related complications. Cesarean scar site diverticulum or isthmocele is one such complication that is defined as an outpouching of the anterior uterine wall at the cesarean scar site in continuity with the endometrial cavity, creating a wedge-shaped defect of variable depth. We report a case of a middle-aged female with secondary infertility for the last 11 years with one live issue 12 years back through a cesarean section at term. She had undergone an array of investigations for infertility for the past 5 years. She was diagnosed as having an isthmocele and managed with surgical repair of the defect at our hospital with subsequent assisted conception 8-month post-surgical repair. The importance of diagnosing a cesarean scar diverticulum cannot be understated not only because it is a surgically treatable cause of infertility but also because if such patients conceive, they may land in uterine rupture, placenta accreta, or scar ectopic pregnancy which can complicate into life-threatening situations.
الملخص
Post-operative ascites following caesarean section is rarely reported in pregnancy. Ascites has multiple etiologies including malignancies, liver cirrhosis, intraperitoneal infections and trauma. Authors report a case of post-operative ascites following caesarean section performed at around 37 weeks of gestation. The patient was normotensive. The diagnosis and treatment of ascites as well as the pregnancy outcome is presented. Literature review of ascites in pregnancy is discussed as well. This case was that of an idiopathic ascites with no definitive cause. An allergic or inflammatory peritoneal reaction may be the most likely cause for this complication.
الملخص
OBJECTIVE: After globally acceptance of planned vaginal birth after cesarean section (VBAC), the mode of induction is still a matter of debate and requires further discussion. We aimed to study obstetric outcomes in post-cesarean patients undergoing induction of labor with prostaglandin gel compared with patients who developed spontaneous labor pains. METHODS: All patients at 34 weeks or more of gestation with previous one cesarean section eligible for trial of labor after cesarean section admitted in a labor room within one year were divided in 2 groups. Group one consisted of patients who experienced the spontaneous onset of labor pains and group 2 consisted of patients who underwent induction of labor with prostaglandin gel. They were analyzed for maternofetal outcomes. Descriptive statistics, independent sample t-test, and chi-square test were applied using SPSS 20 software for statistical analysis. RESULTS: Both groups were comparable in maternal age, parity, and fetal weight, but different in bishop score, mode of delivery, and neonatal outcome. Admisson bishop score was 6.61±2.51 in group 1 and 3.15±1.27 in group 2 (P<0.005). In the patients who experienced spontaneous labor, 86.82% had successful VBAC. In the patients with induced labor, 64.34% had successful VBAC with an average dose of gel of 1.65±0.75. Both groups had one case each of uterine rupture. The neonatal intensive care unit admission rate was 4.1% in group one and 10.4% in group 2. CONCLUSION: This study reflects that supervised labor induction with prostaglandin gel in previous one cesarean section patients is a safe and effective option.
الموضوعات
Female , Humans , Infant, Newborn , Pregnancy , Cesarean Section , Fetal Weight , Intensive Care, Neonatal , Labor Pain , Labor, Induced , Maternal Age , Parity , Prostaglandins , Trial of Labor , Uterine Rupture , Vaginal Birth after Cesareanالملخص
Background: Post-cesarean pain is a common cause of acute pain in the obstetrics. Pain in the postoperative period is an important impediment to recovery from surgery and anesthesia. This study was conducted to evaluate the efficacy of postoperative analgesia and incidence of side-effects of centrally acting drug tramadol with peripherally acting drug diclofenac alone and in combination in patients undergoing elective cesarean delivery under spinal anesthesia. Methods: The study population of 90 patients was randomly divided into three groups of 30 each to receive the following treatments: tramadol (Group T), diclofenac (Group D), tramadol and diclofenac at reduced doses (Group TD). Results: Combination of tramadol and diclofenac produced significantly early analgesia in comparison to tramadol or diclofenac alone and decrease in the incidence of side-effects. Conclusion: We conclude that a multimodal approach to post-cesarean management with a combination of tramadol and diclofenac produced better analgesia than individual drugs and a reduction in the side-effects. Such a combination approach to relieve pain is more effective and advantageous.
الملخص
Introducción: desde 1916 se dice una vez cesárea, siempre cesárea, debido fundamentalmente a la técnica corpórea, que conllevaba un elevado riesgo de rotura uterina y alta mortalidad. Con la incisión segmentaria que daña menos fibras musculares y tiene una mejor cicatrización, disminuyó el riesgo de rotura en pacientes con cesárea anterior sometidas a trabajo de parto. Objetivo: determinar resultados maternos y perinatales en mujeres con cesárea previa. Métodos: se realizó un estudio descriptivo y transversal de 129 pacientes con antecedentes de cesárea que iniciaron trabajo de parto espontáneamente entre el 1ro. de enero y 31 de diciembre de 2008. Se atendieron mediante parto vaginal si la indicación de la cesárea no persistía. Se analizaron las causas de las cesáreas en aquellas gestantes en que no se logró un parto transpelviano, se estudió el período intergenésico y las complicaciones maternas y fetales. Se elaboraron tablas de frecuencia con valores absolutos y porcentajes según las diferentes variables estudiadas; así como tablas de doble entrada. Resultados: se apreció que el 72,9 por ciento de las pacientes tuvieron un parto transpelviano y al resto se les realizó cesárea iterada, cuyas principales causas fueron trabajo de parto prolongado, desproporciones cefalopélvicas e inminencia de rotura uterina. Dos pacientes presentaron rotura uterina, ambas con período intergenésico menor de 24 meses. El bienestar fetal alterado se presentó en el 31,4 por ciento de las pacientes. Conclusiones: el parto poscesárea es recomendable en pacientes seleccionadas si se tienen en cuenta los riesgos y complicaciones que este puede conllevar
Introduction: from 1916 it says that once cesarean section, always cesarean section mainly due to the corporeal technique leading to a high risk of uterine rupture and a high mortality rate. With the segmental incision affecting less muscular fibers and a better healing, the above mentioned rupture decreased in patients with a prior cesarean section underwent labor. Objective: to determine the maternal and perinatal results in women underwent a prior cesarean section. Methods: a cross-sectional and descriptive study was conducted in 129 patients with a history of cesarean section starting the labor from January,1 to December, 2008. They were care for by vaginal delivery if the prescription of cesarean section was not remains. Authors analyzed the cesarean section causes in those pregnants where the transpelvic delivery failed, studying the inter-genesis period and the mother and fetus complications. Frequency tables were designed with absolute values and percentages according to the different study variables, as well as the two-entry tables. Results: it was noted that the 72.9 percent of patients had a transpelvic delivery and remainder underwent cesarean section, whose major causes were the prolonged labor, cephalopelvic disproportions and an imminent uterine rupture, both with a inter-genesis period less than 24 months. The altered fetal wellbeing was present in the 31.4 percent of patients. Conclusions: the post-cesarean section delivery is recommendable in select patients if it is taking into account the risks and complications related to this technique
الملخص
Postpartum endomyometritis is an important cause of maternal morbidity, especially after cesarean delivery. The management of postpartum endomyometritis is primarily medical with surgical intervention only occasionally required. But the gas forming abscess rarely happens, making the medical treatment difficult and needing emergency hysterectomy. We present a case of post-cesarean delivery endomyometritis complicated by intrauterine gas formation penetrating myometrium, which could not be managed by medical treatment, so finally needed emergency hysterectomy.
الموضوعات
Animals , Female , Mice , Abscess , Emergencies , Endometritis , Hysterectomy , Myometrium , Postpartum Periodالملخص
Objective To investigate the value of interventional embolism in diagnosing etiological factor and treatment of the late stage of hemorrhage of uterus post-cesarean section.Methods Angiography and embolism through super-selective bilateral internal iliac artery and uterine artery in 56 patients with late stage of hemorrhage in uterus after cesarean section were performed with Seldinger technique.Results All patients were treated successfully and no complication presented.Conclusion Interventional embolism is of important value in treating the late stage of hemorrhage in uterus after cesarean section.