Surgical treatment of uterine atony employing the B-Lynch technique.

Postpartum hemorrhage remains a major cause of maternal morbidity and mortality. Four cases utilizing the B-Lynch technique for control of hemorrhage secondary to uterine atony are presented. The B-Lynch technique appears to be effective in controlling postpartum hemorrhage. More experience is needed before the B-Lynch technique can be accepted as routine practice.

Activated protein C resistance and lupus anticoagulant in pregnancy.

Thrombophilias, both inherited and acquired, have been reported to be associated with thromboembolic events and severe obstetric complications. This case report examines the case of a patient with two thrombophilias, activated protein C resistance secondary to Factor V Leiden mutation and lupus anticoagulant.

The effect of a resident night team on cesarean delivery.

We tested the hypothesis that the implementation of a resident night team would change the rate of, the indications for, and the time of day of cesarean delivery. A retrospective chart review was performed on patients who underwent cesarean birth during two time periods. Charts of 1722 patients who had a cesarean delivery between January 1, 1990 through June 30, 1991 (control group) and January 1, 1992 through June 30, 1993 (study group after implementation of a resident night team) were abstracted. All patients were cared for only by resident physicians and all patients delivered during a workweek defined as Sunday 1700 through Friday 0700. Each workday was divided into three shifts (0001-0700; 0701-1700; and 1701-2400) for analysis. After implementation of the night team, the cesarean rate increased (p < 0.002), the proportion of planned repeat cesarean deliveries decreased, the proportion of cesareans for malpresentation decreased (p < 0.005), and the proportion of cesareans for arrest of labor increased (p < 0.0001). These changes were not associated with a change in the temporal distribution for any indication among the three shifts. The implementation of a resident night team did not change the time of day distribution of cesarean delivery for any of six indications.

Amniotomy to induce labor.

Amniotomy to induce labor is used frequently. The potential risks compared with potential benefits of artificial rupture of membranes have caused the popularity of amniotomy to vary in the last two centuries. Although there are little data available from prospective randomized studies regarding the effectiveness of amniotomy alone to induce labor, several series have showed success in its use. In addition, no well-accepted, prospectively randomized study is available comparing the effectiveness of amniotomy to oxytocin for induction of labor. The most effective combination of amniotomy with uterotonic agents to induce labor is still a fertile area for investigation.

Climatic factors and the incidence of pyelonephritis during pregnancy.

OBJECTIVE: Numerous published reports have linked various disease states and pregnancy-related conditions with meteorologic factors such as weather, humidity, and temperature. The purpose of this study was to determine if temperature and dew point affect the incidence of pyelonephritis during pregnancy. METHODS: A retrospective chart review of a 4-year period from 1989 to 1992 was performed. The records of women who were diagnosed with pyelonephritis during pregnancy were abstracted for the dates of admission. The climatic records of the Tampa Bay area of Florida were obtained from the National Weather Service. RESULTS: The average, minimum, or maximum daily temperature or average daily dew point during the month of admission had no significant effect on the rate of pyelonephritis during pregnancy in the Tampa Bay area. CONCLUSIONS: The rate of pyelonephritis during pregnancy per number of deliveries in the Tampa Bay area was not affected by the average, minimum, or maximum daily temperature or average daily dew point.