RESUMO
OBJECTIVE: To investigate whether manual removal of the placenta is associated with significant blood loss compared with spontaneous separation of the placenta during cesarean delivery. DESIGN: A randomized prospective study of 400 women with normal pregnancies undergoing cesarean delivery at King Abdulaziz University Hospital, Jeddah, Saudi Arabia. Patients were randomly assigned to the study group, (manual placental removal, n=200) or the control group (spontaneous placental separation, n=200). Operative blood loss was assessed by the volumetric and gravimetric methods. Hemoglobin levels were evaluated the third postoperative day and patient's postoperative complications were recorded. RESULTS: The mean+/-S.D. amount of blood loss associated with manual and spontaneous removal of the placenta was 713+/-240 and 669+/-253 ml, respectively. This difference was statistically significant (P=0.04). There was a postoperative decrease in hemoglobin levels in both groups. Preoperative hemoglobin levels were 11.6+/-3 g/dl in the study group and 11.2+/-1.1 g/dl in the control group, and the difference was statistically significant (P=0.006). The postoperative hemoglobin levels at day 3 were 9.0+/-1.2 g/dl in the study group and 9.9+/-1.2 g/dl in the control group (P=0.003), also a statistically significant difference. The incidence of endometritis, wound infection, and need for blood transfusion was similar in the two groups. CONCLUSION: Manual delivery of the placenta was significantly associated with greater operative blood loss and greater decrease in postoperative hemoglobin levels, but with shorter operative time compared with spontaneous placental separation. No difference in postoperative complications was noted between the groups.
Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Cesárea/métodos , Placenta/cirurgia , Adulto , Volume Sanguíneo , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Gravidez , Estudos Prospectivos , Resultado do TratamentoRESUMO
A case of cephalothoracopagus conjoined twins (Janiceps twins) is presented. The abnormality was detected antenatally by the use of ultrasonography and confirmed postnatally, clinically and by computed tomography (CT scan).
Assuntos
Anormalidades Múltiplas/diagnóstico , Diagnóstico Pré-Natal , Gêmeos Unidos , Anormalidades Múltiplas/diagnóstico por imagem , Anormalidades Múltiplas/patologia , Adulto , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Tomografia Computadorizada por Raios X , Gêmeos Unidos/patologia , Ultrassonografia Pré-NatalRESUMO
We report a rare case of Meckel-Gruber syndrome in a woman who had three affected offsprings in the past with similar condition. Ante-natal ultrasonographic diagnosis and management are presented.