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1.
Medicine (Baltimore) ; 99(1): e16791, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895764

RESUMO

The present study aimed to investigate the feasibility of vaginal delivery combined with vaginal tightening surgery and perineal body repair.From January 2017 to April 2017, 5 cases underwent vaginal delivery combined with vaginal tightening surgery and perineal body repair. We retrospectively analyzed the clinical data.The incisions of 5 cases were all primary healing; vulva form was improved, and there were no postoperative hematoma, infection or vaginal mucosa prolapse. Sexual function was improved to different degrees. The pelvic muscle force test showed that both the type I and type II myofiber scores were increased.It is feasible to perform vaginal delivery combined with vaginal tightening surgery and perineal body repair, which is a safe and effective method for improving sex life and pelvic floor function.


Assuntos
Parto Obstétrico/efeitos adversos , Vagina/cirurgia , Adulto , Feminino , Humanos , Lacerações/etiologia , Lacerações/cirurgia , Diafragma da Pelve/fisiopatologia , Diafragma da Pelve/cirurgia , Períneo/lesões , Períneo/cirurgia , Gravidez , Qualidade de Vida , Vagina/fisiopatologia , Vulva/cirurgia
2.
BJOG ; 127(3): 397-403, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31749273

RESUMO

OBJECTIVE: To determine whether restrictive or routine episiotomy in term pregnant Southeast Asian women results in fewer complications. DESIGN: A multicentre randomised controlled trial. SETTING: Two tertiary and two general hospitals in Thailand. POPULATION: 3006 singleton pregnant women 18 years or older, ≥37 weeks of gestation, cephalic presentation and planned vaginal delivery. METHODS: This randomised controlled trial compared routine versus restrictive episiotomies in Thai women giving birth vaginally. Participants were singleton, term pregnant women with cephalic presentation. Block randomisation was stratified by study site and parity. Risk ratios (RR) and 95% confidence intervals (CI) were calculated to indicate between-group differences. MAIN OUTCOME MEASURES: Primary outcome was severe perineal laceration. Secondary outcomes included vaginal laceration, cervical laceration, and pregnancy outcomes. RESULTS: 3006 women were randomly assigned to restrictive (1502) and routine (1504) episiotomy. There was no difference in severe perineal laceration between the groups (RR 0.72, 95% CI 0.46-1.12). Restrictive episiotomy resulted in more intact perineums in multiparous women (RR 3.09, 95% CI 2.10-4.56). Restrictive episiotomy increased the risk of vaginal laceration in primiparous (RR 1.96, 95% CI 1.62-2.37) and multiparous women (RR 2.21, 95% CI 1.77-2.75) but did not lead to more suturing. There were comparable risks of cervical laceration, postpartum haemorrhage, wound complication, birth asphyxia, and admission to neonatal intensive care unit. CONCLUSIONS: Restrictive episiotomy results in more intact perineum in multiparous women. Risks of maternal and neonatal outcomes were comparable between the two practices. These results strengthen the certainty of the existing Cochrane review findings in supporting restrictive episiotomy. TWEETABLE ABSTRACT: Restrictive episiotomy results in more intact perineums after vaginal birth in multiparous Southeast Asian women.


Assuntos
Parto Obstétrico , Episiotomia , Complicações Intraoperatórias , Lacerações , Períneo/lesões , Adulto , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Episiotomia/efeitos adversos , Episiotomia/métodos , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/prevenção & controle , Apresentação no Trabalho de Parto , Lacerações/diagnóstico , Lacerações/etiologia , Lacerações/prevenção & controle , Paridade , Gravidez , Resultado da Gravidez/epidemiologia , Risco Ajustado/métodos , Nascimento a Termo , Tailândia
3.
Ceska Gynekol ; 84(2): 93-98, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238678

RESUMO

OBJECTIVE: Evaluation of maternal and neonatal outcomes in operative vaginal deliveries in prospective study analysis. DESIGN: Prospective case-control study analysis. SETTING: Prospective analysis of 292 operative vaginal deliveries (VEX, forceps) for the period June 2016 - August 2017 from overall 6056 vaginal deliveries. Type and frequency of maternal and neonatal trauma occurence was observed in connection with using vacuum-assisted delivery and forceps delivery, mainly the cephalohematomas and their complications. Collected data were statistically analysed. RESULTS: In the reported period from overall 6056 deliveries there were 216 vacuumextractions (3.6%) and 72 forceps deliveries (1.2%) performed. Both methods were used in four patients (VEX and forceps). The most frequent trauma in newborns were cephalohematomas. Remarkable cephalohematoma, requiring further observation has occured in 40 newborns (18.5%) after vacuum-assisted delivery and in 5 newborns (6.9%), (p = 0,017) after forceps delivery. Consequential punction of cephalohematoma occured only after vacuumextraction delivery and in 6 newborns (15.0 %). The third degree perineal rupture occured after vacuumextraction in 20 patients (9.3%) and after forceps delivery in 12 patients (16.7%), (p = 0,091). The fourth degree perineal rupture occured only after vacuumextraction and in 1 case (0.5%). CONCLUSION: The vacuumextraction compared with forceps is more likely to be associated with the statistically significant incidence of cephalohematomas and their further treatment. Forceps deliveries compared with vacuumextraction are more likely to be associated with the maternal perineal trauma, but the diference was not statistically significant.


Assuntos
Traumatismos do Nascimento/etiologia , Genitália Feminina/lesões , Hematoma/etiologia , Lacerações/etiologia , Forceps Obstétrico/efeitos adversos , Vácuo-Extração/efeitos adversos , Estudos de Casos e Controles , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Estudos Prospectivos
4.
BMC Pregnancy Childbirth ; 19(1): 207, 2019 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221110

RESUMO

BACKGROUND: The objectives of this study were to explore the course of labor and the risk of obstetric anal sphincter injury at the first vaginal birth after cesarean section (fVBAC) in comparison to primiparous vaginal birth (PVB) in women without epidural analgesia and to assess if laboring before the previous cesarean affected these outcomes. METHODS: All fVBACs without epidural analgesia and the subsequent PVBs (controls) between 2012 and 2016 were included in this retrospective cohort study. Data were collected from health records and included maternal demographics, gestational age, and labor details (duration of 1st and 2nd stages, labor induction or augmentation, birthweight, operative vaginal birth, estimated blood loss, extent of childbirth trauma) in both groups as well as cervical dilation at the time of previous cesarean in the fVBAC group. Wilcoxon and Chi-square tests were used for data analyses. RESULTS: The study comprised 510 women; 255 fVBACs and 255 controls. The majority of fVBACs were after a pre-labor cesarean section - 177 (69.4%). There was a statistically significant difference in the recorded duration of first stage between the fVBACs and controls (289 vs. 347 min respectively, p < .001). Women were less likely to have an intact perineum in the fVBAC group (29.8 vs. 43.1%, p < 0.01), however, there was no statistically significant difference in anal sphincter injury rates between both groups (2.3 vs. 1.9%, p = 0.76). The groups differed in rates of cervical tears requiring suturing (21.2 vs. 12.9%, p = 0.01). On further subgroup analysis, the duration of first stage of labor was shorter in women who previously had a caesarean section late in labor (≥ 8 cm cervical dilatation) compared to a pre-labor cesarean section, however, there were no differences in other outcomes. CONCLUSION: Compared to primiparous women having a vaginal birth, women having their first vaginal birth after a cesarean section have a shorter 1st stage of labor (particularly if the cesarean was performed in advanced labor), a higher risk of sustaining cervical lacerations and perineal trauma. However, there was no difference in the risk of sustaining obstetric anal sphincter injuries between the study groups.


Assuntos
Canal Anal/lesões , Colo do Útero/lesões , Cesárea , Primeira Fase do Trabalho de Parto , Períneo/lesões , Nascimento Vaginal Após Cesárea/efeitos adversos , Adulto , Feminino , Humanos , Lacerações/etiologia , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
5.
PLoS One ; 14(4): e0215180, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30973931

RESUMO

This study aimed to investigate the reproductive impact of a third- or fourth-degree tear in primigravid women. A retrospective population-based cohort study was conducted using data from Scottish Morbidity Records (SMR02). Primigravid women with a vaginal birth in Scotland from 1997 until 2010 were included. Exposure was third- or fourth-degree tear in the first pregnancy. The second pregnancy rate, interpregnancy interval and third- or fourth-degree tear in a second pregnancy were the primary outcomes. A nested case-control study was used to determine factors associated with repeat third- or fourth-degree tears in a second vaginal birth. Cox regression analysis and logistic regression were used to look for associations. Initial third- or fourth-degree tear occurred in 2.8% women (5174/182445). The percentage of third- or fourth-degree tears in first vaginal births increased from 1% in 1997 to 4.9% in 2010. There was no difference in having a second pregnancy (adjusted Odds Ratio (aOR) 0.98 (99%CI 0.89-1.09)) or the median interpregnancy interval to second pregnancy (adjusted Hazard Ratio (aHR) 1.01 (99%CI 0.95-1.08)) after an initial third- or fourth-degree tear. Women were over four times more likely to have a repeat injury in a subsequent vaginal birth (n = 149/333, aOR 4.68 (99% 3.52-6.23)) and were significantly more likely to have an elective caesarean section in their second pregnancy (n = 887/3333, 26.6%; 12.75 (11.29-14.40)). Increased maternal age and birthweight ≥4500g were risk factors for repeat injury. Third- and fourth-degree tears are increasing in Scotland. Women do not delay or avoid childbirth after initial third- or fourth-degree tear. However, women are more likely to have a repeat third- or fourth-degree tear or an elective caesarean section in the second pregnancy. Strategies to prevent third- or fourth-degree tears are needed.


Assuntos
Complicações do Trabalho de Parto/etiologia , Períneo/lesões , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Número de Gestações , Humanos , Lacerações/etiologia , Modelos Logísticos , Complicações do Trabalho de Parto/epidemiologia , Parto , Gravidez , Modelos de Riscos Proporcionais , Recidiva , Estudos Retrospectivos , Fatores de Risco , Escócia/epidemiologia , Adulto Jovem
6.
BMC Pregnancy Childbirth ; 19(1): 52, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30700256

RESUMO

BACKGROUND: In regard to obstetrical analgesia management there are different results related to the use of epidural analgesia versus mechanical adverse outcomes at delivery. METHODS: Cohort study of 23,183 consecutive, term, singleton vaginal deliveries, including spontaneous and induced labours, at a single institution from January 2004 to June 2016 to determine the association between epidural analgesia and different mechanical complications affecting maternal health such as severe perineal tears (SPT), abnormal foetal head position at delivery, instrumental delivery and caesarean section (CS). Multivariate logistic regression models were constructed to evaluate the risk factors of these mechanical complications with respect to possible cofounders. RESULTS: Epidural analgesia was used in 15,821 (68.24%) women. The logistic regression model showed a non-significant association between the use of epidural analgesia and SPT (odds ratio [OR], 078; 95% confidence interval [CI], 0.48-1.26; p = 0.310). Instrumental delivery and CSs were more frequently performed in cases than controls (p = < 0.001), with OR of 1.19 (95% CI: 1.10-1.29) for CS and with OR of 3.27 (95% CI: 2.93-4.61) for instrumental delivery. The abnormal foetal position head at delivery were significantly lower in the neonates delivered without epidural analgesia compared with those in which epidural analgesia was used (p < 0.001) with OR of 1.43 (95% CI:1.27-1.72). CONCLUSIONS: Epidural analgesia is not associated with an increase of SPT, but it was an independent risk factor for instrumental delivery, CS and abnormal foetal head position at delivery.


Assuntos
Analgesia Epidural/efeitos adversos , Analgesia Obstétrica/efeitos adversos , Lacerações/etiologia , Complicações do Trabalho de Parto/etiologia , Períneo/lesões , Adulto , Analgesia Obstétrica/métodos , Parto Obstétrico/métodos , Feminino , Humanos , Apresentação no Trabalho de Parto , Lacerações/epidemiologia , Modelos Logísticos , Análise Multivariada , Complicações do Trabalho de Parto/epidemiologia , Razão de Chances , Paridade , Gravidez , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia
7.
Arch Soc Esp Oftalmol ; 94(5): 242-247, 2019 May.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30733068

RESUMO

An 80 year-old woman with no relevant medical history, consulted for worsening of right palpebral itching and pain after an insect bite. Her eyelids had areas of laceration due to scratching, which rapidly progressed to fibrinoid necrosis over the first 24hours. Lesions were cultivated, revealing Streptococcus pyogenes and Staphylococcus aureus. The patient was admitted to hospital with the diagnosis of periorbital necrotising fasciitis, in order to receive treatment with intravenous ceftriaxone, linezolid, and immediate surgical debridement. She remained in hospital for 17 days. Daily wound management consisted of debridement of necrotic remains, disinfection with chlorhexidine, and wound dressing with mupirocin, sulfadiazine, and miconazole ointments. The patient suffered streptococcal toxic shock syndrome, but she recovered over the first week. Palpebral reconstruction was performed on day 15, consisting of a preauricular total thickness skin graft for the superior eyelid, and lateral malar advancement to cover the lower eyelid. Adequate cosmetic and functional results were obtained.


Assuntos
Fasciite Necrosante/etiologia , Mordeduras e Picadas de Insetos/complicações , Lacerações/etiologia , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Desbridamento , Fasciite Necrosante/terapia , Feminino , Humanos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/isolamento & purificação
8.
J Hand Surg Asian Pac Vol ; 24(1): 123-126, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30760150

RESUMO

We report a case of complete laceration of both flexor tendons in the dominant ring finger of a young male caused by a closed volar fracture fragment of the proximal phalanx. Careful clinical examination, reasonable index of suspicion and ultrasound confirmation play a pivotal role in the diagnosis and surgical planning of this rare yet consequential injury. Good outcomes can be achieved from the surgical management and rehabilitation of both soft tissue and bony injuries when planning of surgical approaches and fixation techniques are facilitated by an accurate pre-operative diagnosis.


Assuntos
Falanges dos Dedos da Mão/lesões , Fraturas Fechadas/complicações , Lacerações/etiologia , Traumatismos dos Tendões/etiologia , Adulto , Falanges dos Dedos da Mão/cirurgia , Fixação Interna de Fraturas , Fraturas Fechadas/cirurgia , Humanos , Lacerações/diagnóstico por imagem , Lacerações/cirurgia , Masculino , Radiografia , Traumatismos dos Tendões/diagnóstico por imagem , Traumatismos dos Tendões/cirurgia , Ultrassonografia
10.
Female Pelvic Med Reconstr Surg ; 25(2): 109-112, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807410

RESUMO

BACKGROUND: An estimated 4% to 6.6% of women delivering vaginally sustain obstetrical anal sphincter injuries (OASI). Despite this, a gap exists in the provision of postpartum care to women globally. Given the negative impact of OASI, action is needed, and multidisciplinary perineal clinics can help. Consequently, such a clinic was established in 2011 at the Royal Alexandra Hospital (RAH), a tertiary care center in Edmonton, Alberta. OBJECTIVE: This study assesses the state of perineal clinics specializing in OASI internationally and locally by investigating the literature for descriptions of specialized perineal clinics for women with OASI, describing the RAH perineal clinic, and assessing the prevalence of OASI at the RAH in the context of the clinic. METHODS: A search of peer-reviewed literature was conducted on Medline and observations and interviews of RAH perineal clinic staff were conducted, as was a medical chart review. RESULTS: Articles describing only 10 perineal clinics specializing in OASI were found, with varying structures. The multidisciplinary RAH clinic, like one other clinic, has a strong physiotherapy focus, with education and Pilates classes and one-on-one appointments offered by pelvic floor physiotherapists. In 2016, of the 326 (6.9%) vaginal deliveries that resulted in OASI at the RAH, only 66.0% (215) were referred to the clinic. CONCLUSIONS: Multidisciplinary perineal clinics are needed globally. Despite the creation of the perineal clinic at the RAH, women continue to lack specialized care after OASI. It is crucial that healthcare professionals specializing in OASI share their experiences to establish best practices and create new, and improve existing, perineal clinics.


Assuntos
Canal Anal/lesões , Lacerações/reabilitação , Ambulatório Hospitalar/estatística & dados numéricos , Períneo/lesões , Alberta , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Lacerações/etiologia , Modalidades de Fisioterapia , Cuidado Pós-Natal , Encaminhamento e Consulta/estatística & dados numéricos
11.
Female Pelvic Med Reconstr Surg ; 25(2): e23-e27, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30807431

RESUMO

OBJECTIVE: The aim of this study was to investigate the effects of postpartum patients introduction to and interaction with a virtual 3-dimensional (3D) pelvic model on the self-care, knowledge, and anxiety parameters. METHODS: The model was designed from computed tomography data displaying the involvement of the levator ani in a fourth-degree perineal laceration. This 3D model was used to educate postpartum day 1 patients at the bedside. Patient data were collected using a pre and post questionnaire assessing knowledge, anxiety, and confidence in perineal wound self-care. RESULTS: Thirty-six patients were enrolled with a median age of 28.5 years (interquartile range, 31, 21.75 years) and a median parity of 1 (interquartile range, 2, 1). Patient use of the tool significantly decreased patient anxiety regarding perineal lacerations (P < 0.01) and significantly increased patient knowledge on what part of their vagina was lacerated during vaginal delivery (P < 0.01). CONCLUSIONS: Reviewing a 3D model of perineal lacerations with patients on postpartum day 1 is associated with less anxiety and increased knowledge of pelvic floor anatomy. These pilot data represent a preliminary investigation into the relations between 3D model of perineal lacerations and a range of patient outcomes.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Lacerações/psicologia , Lacerações/terapia , Modelos Anatômicos , Educação de Pacientes como Assunto/métodos , Períneo/lesões , Adulto , Ansiedade/etiologia , Ansiedade/prevenção & controle , Parto Obstétrico/efeitos adversos , Feminino , Humanos , Lacerações/etiologia , Parto , Projetos Piloto , Estudos Prospectivos , Autocuidado , Autoeficácia , Projetos Ser Humano Visível , Adulto Jovem
12.
Int Urogynecol J ; 30(3): 429-437, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29654350

RESUMO

INTRODUCTION AND HYPOTHESIS: Obstetric anal sphincter injury (OASIS) rates are reported to be higher in Asian women living in Western countries than in those living in Asia, but the reasons for the differences remain unclear. The objectives of this study were for a single examiner to prospectively compare OASIS rates in primiparous Asian women in an Asian and Western birth unit and determine potential birth factors that may influence the possible difference in OASIS incidence. METHODS: This was a prospective observational study based in Hong Kong, China, and Sydney, Australia, involving primiparous women > 36 weeks gestation of Asian descent undergoing vaginal delivery. A single examiner recorded basic patient demographics, observed all the deliveries at both sites, noting birthing techniques, and then examined the women, including a rectal examination, to determine OASIS incidence. RESULTS: Seventy births in Hong Kong and 66 in Sydney were studied. The incidence of OASIS was 34% in Sydney and 10% in Hong Kong (p = 0.001). Birthweight, epidural rate, body mass index, and instrumental delivery were higher in Sydney. Episiotomy rates were higher in Hong Kong (59.2% vs. 82.9%; p = 0.007). When comparing OASIS with no-OASIS, perineal length (OR = 0.36, 95% CI 0.17 to 0.76, p = 0.004) and birthweight (OR = 1.14, 95% CI 1.00 to 1.30, p = 0.039) were independent risk factors for OASIS. CONCLUSIONS: The incidence of OASIS in Asian women is significantly higher in a Western than in an Asian setting. In Asian women, perineal length and birthweight can affect the risk of OASIS at the time of vaginal delivery.


Assuntos
Canal Anal/lesões , Episiotomia/estatística & dados numéricos , Extração Obstétrica/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Lacerações/epidemiologia , Adulto , Anestesia Epidural/estatística & dados numéricos , Ásia/etnologia , Austrália/epidemiologia , Peso ao Nascer , Índice de Massa Corporal , Feminino , Hong Kong/epidemiologia , Humanos , Incidência , Lacerações/etiologia , Períneo/anatomia & histologia , Estudos Prospectivos , Fatores de Risco
13.
J Pediatr Adolesc Gynecol ; 32(2): 135-138, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30447292

RESUMO

STUDY OBJECTIVE: The objective of this study was to describe prevalence and location of obstetric lacerations in adolescents. DESIGN: Retrospective cohort study. SETTING: We performed an analysis of the Consortium on Safe Labor database including tertiary care university-affiliated urban hospitals. PARTICIPANTS: All primiparous women who delivered vaginally were included. INTERVENTIONS: Vaginal and perineal lacerations were compared between age groups 15 or younger, 16-21, 22-34, 35-39, and older than 40 years. MAIN OUTCOME MEASURES: Outcome measures included vaginal, perineal, labial, and periurethral lacerations. χ2 and Fisher exact tests were used as appropriate, with P < .05 considered significant. RESULTS: A total of 9777 patients were included in the analysis. Young adolescents and adolescents had significantly higher rates of labial and periurethral lacerations compared with individuals aged 22-34 years. The prevalence of third- and fourth-degree perineal tears increased with age. CONCLUSION: Adolescent primiparous women are less likely to have severe perineal obstetric tears, but have higher rates of labial and periurethral tears.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Lacerações/epidemiologia , Complicações do Trabalho de Parto/epidemiologia , Gravidez na Adolescência/estatística & dados numéricos , Adolescente , Adulto , Estudos de Coortes , Bases de Dados Factuais , Parto Obstétrico/efeitos adversos , Episiotomia/efeitos adversos , Feminino , Humanos , Lacerações/etiologia , Mães/estatística & dados numéricos , Paridade , Períneo/lesões , Gravidez , Prevalência , Estudos Retrospectivos , Uretra/lesões , Vagina/lesões , Adulto Jovem
14.
Midwifery ; 69: 121-127, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30500727

RESUMO

INTRODUCTION: Diabetes Mellitus in pregnancy is increasing. No existing studies have examined Diabetes Mellitus as the primary exposure for lower genital tract tears after vaginal birth. The objective was to study the association between Diabetes Mellitus (all types combined), Type 1 Diabetes Mellitus, Type 2 Diabetes Mellitus and Gestational Diabetes Mellitus and lower genital tract tears after vaginal birth. MATERIAL AND METHODS: A register-based cohort study of women with singleton pregnancy and without a previous cesarean section at near-term (≥ 35 + 0 weeks) and term (≥ 37 + 0 weeks) gestational age, n = 31,297 at Aarhus University Hospital, Denmark from 1 January 2004 to 31 December 2012. The associations between Diabetes Mellitus and lower genital tract tears were analysed using a fixed multiple logistic regression analyses. RESULTS: Approximately 32,000 women were eligible for the study; 796 women had diabetes (2.5%) and 1318 experienced anal sphincter injury (4.3%). The overall risk of lower genital tract tears was similar among women with a diagnosis of diabetes (Type1 Diabetes Mellitus, Type 2 Diabetes Mellitus, and Gestational Diabetes Mellitus) compared to women without diabetes, except for nulliparous women with Type1 Diabetes Mellitus who experienced a higher risk of episiotomies, crude and adjusted odds ratios (OR 2.13, 95% CI 1.14-3.97) and (OR 2.48, 95% CI 1.21-5.10), respectively. CONCLUSIONS: Women with Diabetes Mellitus without a previous cesarean section who gave birth vaginally to a single child at term or near term did not experienced an increased risk of lower genital tract tears. However, nulliparous women with Type 1 Diabetes Mellitus experienced a higher risk of episiotomy. These results may be used to individualised counselling of women with Diabetes Mellitus regarding mode of birth and may reduce worries about genital tract tears in women with Diabetes Mellitus considering vaginal birth.


Assuntos
Complicações do Diabetes/complicações , Lacerações/etiologia , Trato Gastrointestinal Inferior/lesões , Adulto , Índice de Massa Corporal , Estudos de Coortes , Dinamarca/epidemiologia , Complicações do Diabetes/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Lacerações/classificação , Lacerações/epidemiologia , Trato Gastrointestinal Inferior/fisiopatologia , Trato Gastrointestinal Inferior/cirurgia , Razão de Chances , Gravidez , Estudos Prospectivos , Sistema de Registros/estatística & dados numéricos , Fatores de Risco
15.
Dis Esophagus ; 32(6)2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30462194

RESUMO

Long-term pharyngeal dysphagia is a common complication following head and neck cancer (HNC) therapies. High-level evidence for pharyngoesophageal junction (POJ) dilatation as a treatment in this population is lacking. We aimed to evaluate the safety and efficacy of POJ dilatation in dysphagic HNC survivors. This single-center, single-blind, placebo-controlled trial (St George Hospital, Sydney, Australia) randomly assigned (1:1) HNC survivors with long-term dysphagia (≥12 months postcompleted HNC therapies) to receive either graded endoscopic dilatations or sham dilatation (placebo). Patients were blinded to intervention types. Two strata were used for permuted randomization: (1) HNC therapies (total laryngectomy vs. chemoradiation alone); (2) Prior POJ dilatation (nil vs. previous dilatation). The primary endpoint was a short-term clinical response in swallowing function (3 months), defined as (1) a decrease in Sydney Swallow Questionnaire score by ≥200 or a score ≤ ULN; and (2) satisfactory global clinical assessment. The secondary endpoints were dysphagia relapse and serious adverse events. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000707369). Between 13 January 2013 and 16 January 2017, 41 patients were randomly assigned to endoscopic dilatation (n = 21) or placebo (n = 20). The short-term response rate in the endoscopic dilatation group was 76% (n = 16), compared with 5% (n = 1) in the placebo group (P < 0.001). There were no serious adverse events. The finding of a mucosal tear postdilatation was associated strongly with clinical response (OR 13.4, 95% CI [2.4, 74.9], P = 0.003). Kaplan-Meier estimate of dysphagia relapse is 50% by 9.6 months (95% CI [6.0, 19.2]) from completion of dilatation. Endoscopic dilatation of the POJ is a safe and efficacious therapy for the treatment of long-term dysphagia in HNC survivors. Close follow-up and repeat dilatation are necessary given the high dysphagia relapse rate.


Assuntos
Transtornos de Deglutição/terapia , Deglutição , Dilatação/métodos , Neoplasias de Cabeça e Pescoço/terapia , Idoso , Quimiorradioterapia/efeitos adversos , Doença Crônica , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/fisiopatologia , Dilatação/efeitos adversos , Endoscopia Gastrointestinal/efeitos adversos , Feminino , Humanos , Lacerações/etiologia , Laringectomia/efeitos adversos , Masculino , Pessoa de Meia-Idade , Membrana Mucosa/lesões , Estudos Prospectivos , Recidiva , Método Simples-Cego , Inquéritos e Questionários , Fatores de Tempo
16.
World Neurosurg ; 122: 282-286, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30415047

RESUMO

BACKGROUND: Iatrogenic vertebral artery injury is an uncommon but well recognized complication during cervical spine surgery. Intraoperative surgical repair is extremely challenging, and options for endovascular repair are limited because of the lack of proper equipment in the operating room setting. CASE DESCRIPTION: A 53-year-old woman who presented with myelopathy underwent anterior cervical diskectomy and fusion of C3-7. A significant laceration injury of the left vertebral artery was encountered during surgery, which was salvaged by intraoperative endovascular repair with a covered stent under portable fluoroscopy guidance. The salvage and repair led to the rest of the surgery being finished as planned preoperatively without any consequences. CONCLUSIONS: Vertebral artery injury is an uncommon but severe complication of cervical spine surgery. For uncontrolled bleeding, intraoperative endovascular repair with portable fluoroscopy is warranted and possible. A covered stent can seal the laceration and stop the bleeding completely which enables completion of the surgery.


Assuntos
Perda Sanguínea Cirúrgica , Complicações Intraoperatórias/cirurgia , Stents Metálicos Autoexpansíveis , Artéria Vertebral/lesões , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Feminino , Hemostasia Cirúrgica/métodos , Humanos , Doença Iatrogênica , Degeneração do Disco Intervertebral/cirurgia , Complicações Intraoperatórias/etiologia , Lacerações/etiologia , Lacerações/cirurgia , Pessoa de Meia-Idade , Terapia de Salvação/métodos , Doenças da Medula Espinal/cirurgia , Resultado do Tratamento
17.
J Laparoendosc Adv Surg Tech A ; 29(2): 282-285, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30289351

RESUMO

OBJECTIVE: The feasibility and perspective of pyloric chisel were discussed through the comparison of pyloric chisel and knife in the treatment of hypertrophic pyloric stenosis (HPS) in single-site umbilical laparoscopic pyloromyotomy (SSULP). METHODS: Fifty-eight cases of HPS treated in our hospital from February 2011 to March 2016 were retrospectively analyzed, in which 30 patients underwent pyloric chisel (Pyloric chisel Group) and 28 patients underwent knife (Knife Group). Operative time, estimated blood loss, and complications between the two groups were analyzed. RESULTS: The operative time was shorter in Pyloric chisel Group than Knife Group (P < .05). The estimated blood loss was lower in Pyloric chisel Group than Knife Group (P < .05). The complication was less in Pyloric chisel Group than Knife Group (P < .05). There were 2 cases of mucosal perforations requiring conversions to open in Knife Group. Five cases of serous tearing occurred in the Knife Group. There was 1 case of serous tearing in the Pyloric chisel Group. All patients were followed up for 3 months, and there was no distinct scar in the umbilical. CONCLUSIONS: Patients were satisfied with no distinct scars in abdominal wall by pyloric chisel or knife to treat HPS in SSULP, but pyloric chisel is more effective and safer.


Assuntos
Laparoscopia/instrumentação , Estenose Pilórica Hipertrófica/cirurgia , Piloromiotomia/instrumentação , Perda Sanguínea Cirúrgica , Feminino , Humanos , Recém-Nascido , Lacerações/etiologia , Laparoscopia/efeitos adversos , Tempo de Internação , Masculino , Duração da Cirurgia , Piloromiotomia/efeitos adversos , Piloromiotomia/métodos , Estudos Retrospectivos , Umbigo
18.
Dis Colon Rectum ; 62(3): 348-356, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30543535

RESUMO

BACKGROUND: Obstetric anal sphincter injury is the primary modifiable risk factor for anal incontinence in women. Currently, endoanal ultrasound is most commonly used to detect residual anal sphincter defects after childbirth. Translabial ultrasound has recently been introduced as a noninvasive alternative. OBJECTIVES: This study aimed to determine medium- to long-term outcomes in women after obstetric anal sphincter injuries diagnosed and repaired at delivery. DESIGN: This is a cross-sectional study. SETTINGS: This study was performed in a tertiary obstetric unit. PATIENTS: Between 2005 and 2015, 707 women were diagnosed with obstetric anal sphincter injuries; 146 followed an invitation for follow-up. INTERVENTIONS: Clinical examination, anal manometry, and translabial ultrasound were performed. MAIN OUTCOME MEASURES: The primary outcomes measured were the St Mark incontinence score and the evidence of sphincter disruption on translabial ultrasound. RESULTS: Of 372 contactable patients, 146 attended at a mean follow-up of 6.6 years (1.7-11.9), of which 75 (51%) reported symptoms of anal incontinence with a median "bother score" of 6 (interquartile range, 3-8). Median St Mark score was 3 (interquartile range, 2-5). Twenty-four (16%) had a score of ≥5. Women who had been diagnosed with a 3c/4th degree tear had more symptoms (58% vs 44%), significantly lower mean maximal resting pressure (p < 0.001), maximal squeeze pressure (p < 0.001), and more residual external (p < 0.001) and internal (p = 0.012) sphincter defects in comparison with those who had a 3a/3b tear. Women with residual external sphincter defects had lower mean maximal squeeze pressure (p = 0.02). Residual internal sphincter defects (p = 0.001) and levator avulsion (p = 0.048) are independent risk factors for anal incontinence on multivariate modeling. LIMITATIONS: This study was limited by the lack of predelivery data of bowel symptoms and BMI and incomplete intrapartum documentation of tear grade. CONCLUSIONS: Symptoms of anal incontinence were highly prevalent (51%), with a high bother score of 6. St Mark scores were associated with residual internal anal sphincter defects and levator avulsion. Women who had a higher tear grade showed a higher incidence of residual sphincter defects and lower manometry pressures. See Video Abstract at http://links.lww.com/DCR/A824.


Assuntos
Canal Anal , Incontinência Fecal , Lacerações , Complicações do Trabalho de Parto , Qualidade de Vida , Ruptura , Adulto , Canal Anal/diagnóstico por imagem , Canal Anal/lesões , Canal Anal/fisiopatologia , Austrália/epidemiologia , Estudos Transversais , Endossonografia/métodos , Incontinência Fecal/diagnóstico , Incontinência Fecal/epidemiologia , Incontinência Fecal/etiologia , Incontinência Fecal/fisiopatologia , Feminino , Seguimentos , Humanos , Incidência , Lacerações/diagnóstico , Lacerações/epidemiologia , Lacerações/etiologia , Lacerações/fisiopatologia , Manometria/métodos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/fisiopatologia , Complicações do Trabalho de Parto/psicologia , Gravidez , Fatores de Risco , Ruptura/diagnóstico , Ruptura/epidemiologia , Ruptura/etiologia , Ruptura/fisiopatologia
19.
J Forensic Sci ; 64(1): 284-288, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29989173

RESUMO

Traumatic cardiac ventricular ruptures in children are rare. Only a single case of left ventricular rupture due to child abuse has been reported. We report a child who sustained a fatal left ventricular apical rupture. It appeared to have resulted from hydrostatic forces resulting from abusive blunt thoracic injury. That he was being abused was previously missed when he was presented to the emergency department with facial pyoderma. It was not noted that he also had lip and oral mucosal injury, sites not affected by staph toxins. As a result, his underlying, abusive and secondarily infected, facial flow type scald burn was not appreciated. Within a week thereafter his fatal injury occurred, accompanied by extensive and obvious associated abusive injuries. Postmortem high-detail whole body computed tomography scanning aided the autopsy. Although rare, ventricular rupture from abusive blunt thoracic injury can occur.


Assuntos
Maus-Tratos Infantis/diagnóstico , Ventrículos do Coração/lesões , Lacerações/etiologia , Pré-Escolar , Evolução Fatal , Ventrículos do Coração/patologia , Humanos , Lacerações/patologia , Masculino , Contusões Miocárdicas/patologia , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/etiologia , Derrame Pericárdico/patologia , Fraturas das Costelas/diagnóstico por imagem , Fraturas das Costelas/patologia , Tomografia Computadorizada por Raios X , Imagem Corporal Total
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