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2.
Am J Obstet Gynecol ; 223(5): 709-714, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32888923

RESUMO

Obstetrical perineal and anal sphincter lacerations can be associated with considerable sequelae. The diagnosis of short-term bowel, bladder, and healing problems can be delayed if patients are not seen until the traditional postpartum visit at 4 to 6 weeks. Specialized peripartum clinics create a unique opportunity to collaborate with obstetrical specialists to provide early, individualized care for patients experiencing a variety of pelvic floor issues during pregnancy and in the postpartum period. Although implementation of these clinics requires thoughtful planning and partnering with care providers at all levels in the obstetrics care system, many of the necessary resources are available in routine gynecologic practice. Using a multidisciplinary approach with pelvic floor physical therapists, nurses, advanced practice providers, and other specialists is important for the success of this service line and enhances the level of care provided. Overall, these clinics provide a structured means by which pregnant and postpartum women with pelvic floor symptoms can receive specialized counseling and treatment.


Assuntos
Canal Anal/lesões , Lacerações/terapia , Obstetrícia , Distúrbios do Assoalho Pélvico/terapia , Modalidades de Fisioterapia , Cuidado Pós-Natal/organização & administração , Cuidado Pré-Natal/organização & administração , Parto Obstétrico/efeitos adversos , Dispareunia/terapia , Incontinência Fecal/terapia , Feminino , Humanos , Lacerações/etiologia , Equipe de Assistência ao Paciente , Diafragma da Pelve/lesões , Distúrbios do Assoalho Pélvico/etiologia , Prolapso de Órgão Pélvico/terapia , Dor Pélvica/terapia , Períneo/lesões , Período Periparto , Gravidez , Encaminhamento e Consulta , Incontinência Urinária/terapia
3.
Obstet Gynecol ; 136(4): 707-715, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925614

RESUMO

OBJECTIVE: To compare neonatal intensive care unit (NICU) or special care nursery admission for deliveries with water immersion compared with deliveries in the matched control group without water immersion. Secondary outcomes included adverse neonatal diagnoses, maternal infections, and perineal lacerations. METHODS: We conducted a retrospective study using electronic health record data (2014-2018) from two health systems (eight hospitals), with similar clinical eligibility, associated with low risks of intrapartum complications, and implementation policies for waterbirth. The water immersion group included women intending waterbirth. Water immersion was recorded prospectively during delivery. The comparison population were women who met the clinical eligibility criteria for waterbirth but did not experience water immersion during labor. Comparison cases were matched (1:1) using propensity scores. Outcomes were compared using Fischer's exact tests and logistic regression with stratification by stage of water immersion. RESULTS: Of the 583 women with water immersion, 34.1% (199) experienced first-stage water immersion only, 65.9% (384) experienced second-stage immersion, of whom 12.0% (70) exited during second stage, and 53.9% (314) completed delivery in the water. Neonatal intensive care unit or special care nursery admissions were lower for second-stage water immersion deliveries than deliveries in the control group (odds ratio [OR] 0.3, 95% CI 0.2-0.7). Lacerations were lower in the second-stage immersion group (OR 0.5, 95% CI 0.4-0.7). Neonatal intensive care unit or special care nursery admissions and lacerations were not different between the first-stage immersion group and their matched comparisons. Cord avulsions occurred for 0.8% of second-stage water immersion deliveries compared with none in the control groups. Five-minute Apgar score (less than 7), maternal infections, and other adverse outcomes were not significantly different between either the first- or second-stage water immersion groups and their control group. CONCLUSION: Hospital-based deliveries with second-stage water immersion had lower risk of NICU or special care nursery admission and perineal lacerations than matched deliveries in the control group without water immersion.


Assuntos
Parto Obstétrico , Registros Eletrônicos de Saúde/estatística & dados numéricos , Doenças do Recém-Nascido , Lacerações , Parto Normal , Complicações do Trabalho de Parto , Adulto , Índice de Apgar , Parto Obstétrico/efeitos adversos , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/prevenção & controle , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Segunda Fase do Trabalho de Parto , Lacerações/diagnóstico , Lacerações/etiologia , Lacerações/prevenção & controle , Masculino , Minnesota/epidemiologia , Parto Normal/efeitos adversos , Parto Normal/métodos , Parto Normal/estatística & dados numéricos , Complicações do Trabalho de Parto/diagnóstico , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/prevenção & controle , Períneo/lesões , Gravidez , Resultado da Gravidez/epidemiologia , Estudos Retrospectivos
4.
Obstet Gynecol ; 136(4): 692-697, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925628

RESUMO

OBJECTIVE: To evaluate characteristics associated with adverse outcomes in low-risk nulliparous women randomized to elective labor induction at 39 weeks of gestation or expectant management. METHODS: We conducted a secondary analysis of women randomized during the 38th week to induction at 39 weeks of gestation or expectant management. Deliveries before 39 weeks of gestation and those not adherent to study protocol or with fetal anomalies were excluded. A composite of adverse outcomes (perinatal death or severe neonatal complications), third- or fourth-degree lacerations, and postpartum hemorrhage were evaluated. Log binomial regression models estimated relative risks and 95% CIs for associations of outcomes with patient characteristics including randomly assigned treatment group. Interactions between patient characteristics and treatment group were tested. RESULTS: Of 6,096 women with outcome data, 5,007 (82.1%) met criteria for inclusion in this analysis. Frequency of the perinatal composite was 252 (5.0%), 166 (3.3%) for third- or fourth-degree perineal laceration, and 237 (4.7%) for postpartum hemorrhage. In multivariable analysis, intended labor induction at 39 weeks of gestation was associated with a reduced perinatal composite outcome (4.1% vs 6.0%; adjusted relative risk [aRR] 0.71; 95% CI 0.55-0.90), whereas increasing body mass index (BMI) was associated with an increased perinatal composite outcome (aRR 1.04/unit increase; 95% CI 1.02-1.05). Decreased risk of third- or fourth-degree perineal laceration was observed with increasing BMI (aRR 0.96/unit increase; 95% CI 0.93-0.98) and in Black women compared with White women (1.2% vs 3.9%; aRR 0.34; 95% CI 0.19-0.60). Increased risk of postpartum hemorrhage was observed in Hispanic women compared with White women (6.3% vs 4.0%; aRR 1.64; 95% CI 1.18-2.29). Patient characteristics associated with adverse outcomes were similar between treatment groups (P for interaction >.05). CONCLUSION: Compared with expectant management, intended induction at 39 weeks of gestation was associated with reduced risk of adverse perinatal outcome. Patient characteristics associated with adverse outcomes were few and similar between groups. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT01990612.


Assuntos
Doenças do Recém-Nascido/diagnóstico , Trabalho de Parto Induzido , Lacerações , Complicações do Trabalho de Parto , Hemorragia Pós-Parto , Adulto , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Trabalho de Parto Induzido/efeitos adversos , Trabalho de Parto Induzido/métodos , Lacerações/diagnóstico , Lacerações/etnologia , Lacerações/etiologia , Lacerações/prevenção & controle , Masculino , Parto Normal/efeitos adversos , Parto Normal/métodos , Complicações do Trabalho de Parto/etiologia , Complicações do Trabalho de Parto/prevenção & controle , Avaliação de Processos e Resultados em Cuidados de Saúde , Paridade , Morte Perinatal , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/etnologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez
5.
J Am Acad Orthop Surg ; 28(21): 874-883, 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-32796365

RESUMO

With an increasing number of total hip and knee arthroplasties being done at surgical centers and vascular surgeons often not immediately available in this setting, it is critical for orthopaedic surgeons to be comfortable with the acute surgical management of vascular injuries. Although they are fortunately uncommon in primary total hip and knee arthroplasties, damage to a major artery or vein can have potentially devastating consequences. Surgeons operating both in a hospital and an ambulatory surgical setting should be familiar with techniques to gain proximal control of massive bleeding because the principles can be helpful in primary and revision arthroplasties. In this study, we review the vascular anatomy around the hip and knee and the surgical management of these potentially catastrophic complications.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Complicações Intraoperatórias/etiologia , Lacerações/etiologia , Procedimentos Cirúrgicos Vasculares , Lesões do Sistema Vascular/etiologia , Amputação , Fasciotomia , Hemorragia/etiologia , Quadril/irrigação sanguínea , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/patologia , Complicações Intraoperatórias/cirurgia , Joelho/irrigação sanguínea , Lacerações/diagnóstico , Lacerações/patologia , Lacerações/cirurgia , Neuropatias Fibulares/etiologia , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/patologia , Lesões do Sistema Vascular/cirurgia
6.
Vasc Endovascular Surg ; 54(7): 643-645, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32638641

RESUMO

A 78-year-old male patient was admitted to our hospital after abdominal trauma. Contrast-enhanced computed tomography (CT) scan demonstrated a horseshoe kidney with a perinephric hematoma and evidence of arterial hemorrhage. An anomalous renal arterial anatomy was noted as well, with a renal artery originating from the left common iliac artery. He was successfully treated via an endovascular approach. Varying forms of vascularization may complicate angiographic treatment of patients with abdominal trauma in a setting of kidney anomalies. Obtaining and evaluating contrast-enhanced CT angiography can identify anomalous vessels and can be invaluable when deciding on the most appropriate interventional approach.


Assuntos
Traumatismos Abdominais/terapia , Acidentes por Quedas , Embolização Terapêutica , Procedimentos Endovasculares , Rim Fundido/complicações , Rim/lesões , Lacerações/terapia , Artéria Renal/lesões , Lesões do Sistema Vascular/terapia , Ferimentos não Penetrantes/terapia , Traumatismos Abdominais/diagnóstico por imagem , Traumatismos Abdominais/etiologia , Idoso , Embolização Terapêutica/instrumentação , Procedimentos Endovasculares/instrumentação , Rim Fundido/diagnóstico por imagem , Humanos , Rim/diagnóstico por imagem , Lacerações/diagnóstico por imagem , Lacerações/etiologia , Masculino , Artéria Renal/anormalidades , Artéria Renal/diagnóstico por imagem , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/etiologia , Ferimentos não Penetrantes/diagnóstico por imagem , Ferimentos não Penetrantes/etiologia
7.
Arch Gynecol Obstet ; 302(2): 321-328, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32564129

RESUMO

PURPOSE: Antibiotic treatment during surgical repair of obstetric anal sphincter injuries (OASIS) had been a matter of debate. We aimed to review the available literature regarding the efficacy of metronidazole administration in women undergoing perineal repair following obstetric OASIS. STUDY DESIGN: To identify potentially eligible studies, we searched PubMed, Scopus, Embase and the Cochrane Library from inception to January 13th, 2019.Reference lists of identified studies were searched. No language restrictions were applied. We used a combination of keywords and text words represented by "Metronidazole", "obstetrics", "obstetric anal sphincter injury", "OASIS", "third degree tear", "fourth degree tear", "third degree laceration", "fourth degree laceration", "antibiotic therapy", "perineal damage" and "perineal trauma". Two reviewers independently screened the titles and abstracts of records retrieved from the database searches. Both reviewers recommended studies for the full-text review. Thescreen of full-text articles recommended by at least one reviewer was done independently by the same two reviewers and assessedfor inclusion in the systematic review. Disagreements between reviewers were resolved by consensus. RESULTS: The electronic database search yielded a total of 54,356 results (Fig. 1). After duplicate exclusion 28,154 references remained. Of them, 26 were relevant to the review based on title and abstract screening. None of these articles dealt with the use of metronidazole for the prevention of infections complicating anal sphincter repair in women with OASIS. A Cochrane review addressing antibiotic prophylaxis for patients following OASIS, compared prophylactic antibiotics against placebo or no antibiotics, included only one randomized controlled trial of 147 participants. This study showed that prophylactic antibiotics (not metronidazole) may be helpful to prevent perineal wound complications following OASIS. Fig. 1 Study seection process CONCLUSION: Anaerobic infections potentially complicate wound repair after OASIS. Although scientific societies recommend the use of antibiotics for the prevention of infectious morbidity after OASIS, no study has specifically assessed the role of metronidazole.


Assuntos
Canal Anal/lesões , Antibacterianos/uso terapêutico , Lacerações/etiologia , Metronidazol/uso terapêutico , Períneo/lesões , Infecção dos Ferimentos/prevenção & controle , Ferimentos e Lesões/prevenção & controle , Adulto , Canal Anal/microbiologia , Antibioticoprofilaxia/efeitos adversos , Parto Obstétrico/métodos , Feminino , Humanos , Complicações do Trabalho de Parto/cirurgia , Obstetrícia/métodos , Gravidez , Ferimentos e Lesões/complicações , Ferimentos e Lesões/tratamento farmacológico
10.
BJOG ; 127(11): 1382-1390, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32339378

RESUMO

OBJECTIVE: Women's levels of resilience and attitudes towards perineal lacerations vary greatly. Some women see them as part of the birthing process, while others react with anger, depressed mood or even thoughts of self-harm. A previous study has reported increased risk of postpartum depressive (PPD) symptoms in women with severe perineal lacerations. The aim of this study was to assess the association between severe obstetric perineal lacerations and PPD. A secondary objective was to assess this association among women with low resilience. DESIGN: Nested cohort study. SETTING: Uppsala, Sweden. SAMPLE: Vaginally delivered women with singleton pregnancies (n = 2990). METHODS: The main exposure was obstetric perineal lacerations. Resilience was assessed in gestational week 32 using the Swedish version of the Sense of Coherence Scale. A digital acyclic graph was used to identify possible confounders and mediators. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI). A sub-analysis was run after excluding women with normal or high resilience. MAIN OUTCOME MEASURES: Postpartum depression, assessed with the Depression Self-Reporting Scale, completed at 6 weeks postpartum. RESULTS: There was no significant association between severe obstetric perineal lacerations and PPD at 6 weeks postpartum. However, a significant association was found between severe lacerations and PPD in women with low resilience (OR = 4.8, 95% CI 1.2-20), persisting even after adjusting for confounding factors. CONCLUSION: Healthcare professionals might need to identify women with low resilience, as they are at increased risk for PPD after a severe perineal laceration. TWEETABLE ABSTRACT: Severe perineal lacerations associated with postpartum depression in women with low resilience in a Swedish cohort.


Assuntos
Parto Obstétrico/psicologia , Depressão Pós-Parto/psicologia , Lacerações/psicologia , Complicações do Trabalho de Parto/psicologia , Períneo/lesões , Resiliência Psicológica , Adulto , Parto Obstétrico/efeitos adversos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lacerações/etiologia , Modelos Logísticos , Gravidez , Fatores de Risco , Suécia
12.
Clin Sports Med ; 39(2): 259-277, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32115084

RESUMO

An athlete's hands are susceptible to a variety of acute and cumulative traumas depending on their chosen sport. Depending on the timing of the injury, the immediate requirements of the athlete, and future aspirations, treatment strategies may need individual customization. This article offers a brief review of the anatomy and complex function of the extensor mechanism, discusses the etiologies of various extensor injuries, and outlines the multiple treatment options and expected outcomes.


Assuntos
Traumatismos em Atletas/terapia , Traumatismos dos Dedos/terapia , Traumatismos dos Tendões/terapia , Traumatismos em Atletas/etiologia , Tratamento Conservador , Transtornos Traumáticos Cumulativos/etiologia , Transtornos Traumáticos Cumulativos/terapia , Traumatismos dos Dedos/etiologia , Humanos , Lacerações/etiologia , Lacerações/terapia , Traumatismos dos Tendões/etiologia , Tendões/anatomia & histologia , Tempo para o Tratamento , Punho/anatomia & histologia
14.
J Hand Surg Asian Pac Vol ; 25(1): 47-53, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000597

RESUMO

Background: Self-inflicted wrist lacerations have the potential to lead to crippling sequelae and repeated suicidal attempt. To obtain good results, we have treated self-inflicted wrist lacerations using a multidisciplinary team - emergency, hand surgery, psychiatry, and rehabilitation. This study aims to review features of this type of injuries and suggest multidisciplinary team approach as an optimal treatment. Methods: Our multidisciplinary approach can be summarized as follows: initial evaluation, psychological interview, surgery, and rehabilitation. The medical records including wound features, injured structures and psychological data were reviewed retrospectively. Assessment of functional outcomes, and comparative analysis of various psychological parameters were conducted. Results: Most patients resulted in excellent or good functional outcomes. Five patients reattempted wrist cutting with suicidal intent during follow-up. Only 21.3% patients had a suicidal intent and it was not associated with injury severity and functional recovery. Alcohol ingestion and presence of associated injuries was significant different between severity groups. Presence of suicidal intent was irrelevant to injury severity and functional recovery, but relevant to alcohol ingestion, presence of associated injuries and presence of psychiatric diagnosis. Conclusions: In order to minimize catastrophic disability and repeated suicide attempts, a balanced multidisciplinary approach is one of the best methods to obtain excellent functional outcomes and prevent repeated injuries in patients with self-inflicted wrist lacerations.


Assuntos
Lacerações/diagnóstico , Lacerações/terapia , Tentativa de Suicídio , Traumatismos do Punho/diagnóstico , Traumatismos do Punho/terapia , Adolescente , Adulto , Idoso , Serviço Hospitalar de Emergência , Feminino , Humanos , Lacerações/etiologia , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Estudos Retrospectivos , Traumatismos do Punho/etiologia , Adulto Jovem
15.
Am J Perinatol ; 37(1): 119-126, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31905409

RESUMO

OBJECTIVE: The placement of a cervical cerclage in early pregnancy could influence subsequent labor outcomes at term. Prior studies have yielded conflicting results regarding the potential association with adverse labor outcomes such as cesarean delivery (CD), cervical laceration, and prolonged labor. Our objective was to evaluate rate of CD and adverse maternal outcomes in women who labored at term with and without a cerclage within the Consortium on Safe Labor (CSL) cohort. We hypothesize that women with a cerclage in the incident pregnancy will have an increased frequency of CD and other adverse term labor outcomes. STUDY DESIGN: A retrospective cohort study was performed using data from the CSL. Women with live nonanomalous singleton gestations≥ 37 weeks with induced or spontaneous labor were identified. The risk of CD and other maternal and neonatal outcomes were compared between women with and without cerclage placement during pregnancy. Univariable and multivariable analyses were performed with adjustment for confounding factors. Planned subgroup analysis by history of CD was performed. RESULTS: A total of 374 of the 147,463 patients who met study inclusion criteria in the CSL (0.25%) had a cerclage. In univariable analysis, cerclage placement was associated with a significant increase in the frequency of CD (17.1 vs. 12.8%, p = 0.016, odds ratio: 1.4, 95% CI: 1.07-1.84), cervical lacerations, infectious morbidity, and blood loss. The association with CD persisted in multivariable regression. Cerclage placement was not associated with an increased risk of neonatal morbidity. CONCLUSION: Cerclage placement in pregnancy is associated with an increased risk of CD, cervical laceration, and infectious morbidity among women delivering at term. These findings suggest that cerclage placement may impact labor progression and outcomes. However, the magnitude of the association may not alter clinical decisions regarding cerclage placement in appropriate candidates.


Assuntos
Cerclagem Cervical/efeitos adversos , Colo do Útero/lesões , Cesárea/estatística & dados numéricos , Resultado da Gravidez , Adulto , Análise de Variância , Corioamnionite/etiologia , Estudos de Coortes , Fatores de Confusão Epidemiológicos , Bases de Dados Factuais , Feminino , Humanos , Trabalho de Parto , Lacerações/etiologia , Idade Materna , Hemorragia Pós-Parto/etiologia , Gravidez , Complicações Infecciosas na Gravidez/etiologia , Análise de Regressão , Estudos Retrospectivos , Nascimento a Termo , Estados Unidos , Adulto Jovem
16.
Am Heart J ; 221: 19-28, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31896037

RESUMO

BACKGROUND: Although there have been several reports documenting complications related with transesophageal echocardiography (TEE) manipulation following cardiac surgery, there is a paucity of data regarding the safety of TEE used to guide catheter-based interventions. The aim of this study was to determine the prevalence, types and risk factors of complications associated with procedures requiring active TEE guidance. METHODS: This study included 1249 consecutive patients undergoing either transcatheter aortic valve implantation (TAVI), Mitraclip, left atrial appendage occlusion (LAAO) or paravalvular leak closure (PVLC). Patients were divided into 2 cohorts based on the degree of probe manipulation required to guide the procedure and the risk of developing a TEE-related complication: low-risk (TAVI, n = 1037) and high-risk (Mitraclip, LAAO and PVLC, n = 212). Patients were further analyzed according to the occurrence of major and minor TEE-related complications. RESULTS: The overall incidence of TEE-related complications was 0.9% in the TAVI group and 6.1% in the rest of the cohort (P < .001). Patients in the high-risk cohort had also a higher incidence of major-complications (2.8% vs 0.6%, P = .008), and factors associated with an increased risk were being underweight, having a prior history of gastrointestinal bleeding and the use of chronic steroids/immunosuppressive medications. Procedural time under TEE-manipulation was longer in patients exhibiting complications and was an independent predictor of major complications (OR = 1.13, 95% CI 1.01-1.25, for each 10 minutes increments in imaging time). Patients with major complications undergoing Mitraclip had the longest median time under TEE-manipulation (297 minutes) and a risk of developing a major-complication that was 10.64 times higher than the rest of the cohort (95% CI 3.30-34.29, P < .001). CONCLUSION: The prevalence of TEE-related complications associated with interventional procedures is higher than previously reported. Undergoing a prolonged procedure, particularly in the setting of Mitraclip, was the main factor linked to TEE-related complications.


Assuntos
Cateterismo Cardíaco/métodos , Transtornos de Deglutição/epidemiologia , Ecocardiografia Transesofagiana/efeitos adversos , Esôfago/lesões , Hemorragia Gastrointestinal/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Apêndice Atrial/cirurgia , Transfusão de Sangue , Perfuração Esofágica/epidemiologia , Perfuração Esofágica/etiologia , Feminino , Hemorragia Gastrointestinal/etiologia , Hemorragia Gastrointestinal/terapia , Humanos , Lacerações/epidemiologia , Lacerações/etiologia , Masculino , Valva Mitral/cirurgia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Cirurgia Assistida por Computador , Fatores de Tempo
17.
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
18.
J Matern Fetal Neonatal Med ; 33(5): 883-887, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30189764

RESUMO

Objective: To investigate the significance of intrapartum cervical lacerations on subsequent pregnancies.Study design: A retrospective cohort analysis was conducted, comparing outcomes of subsequent singleton pregnancies, in women with and without a history of cervical lacerations in a previous delivery. Deliveries occurred between the years 1991-2014 at the Soroka University Medical Center. Multiple logistic regression models were constructed to control for clinically significant confounders.Results: During the study period 187,162 deliveries met the inclusion criteria. Of them, 429 (0.2%) occurred in women with a history of cervical lacerations in the previous pregnancy (study group). The study group exhibited significantly higher rates of recurrent cervical lacerations (21/429, 4.9% versus 275/187 162,0.1%, p value = .001), cerclage (13/429, 3% versus 260/187 162, 0.1% p value = .001), cervical incompetence (8/429, 1.9% versus 609/187 162, 0.3% p value = .001) cesarean delivery (CD) (97/429, 22.6% versus 26 280/187 162,14%, p value = .001), severe perineal tears (third or fourth degree; 2/429, 0.5%, versus 164/187 162, 0.1%, p value = .056) and blood transfusion (11/429, 2.6% versus 2448/187 162, 1.3%, p value = .022) as compared with the comparison group. Using a multivariable logistic regression model, history of cervical laceration in a previous pregnancy was found to be an independent risk factor for subsequent CD (OR 1.4, 95% CI 1.1-1.9), recurrent cervical laceration (OR 29.3, 95% CI 17.7-48.5), severe perineal lacerations (OR 11.7, 95% CI 5.1-27.2), and preterm delivery (OR 1.8, 95% CI 1.1-2.8) in the subsequent pregnancy.Conclusions: A history of intrapartum cervical laceration is an independent risk factor for recurrent cervical lacerations, CD, preterm delivery, and severe perineal lacerations in the subsequent pregnancy.


Assuntos
Colo do Útero/lesões , Parto Obstétrico/efeitos adversos , Lacerações/etiologia , Resultado da Gravidez/epidemiologia , Adulto , Feminino , Humanos , Israel/epidemiologia , Gravidez , Recidiva , Estudos Retrospectivos , Adulto Jovem
19.
Women Birth ; 33(1): 15-21, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30642782

RESUMO

BACKGROUND: Birth positions may influence the risk of tears in the genital tract during birth. Birth positions are widely studied yet knowledge on genital tract tears following birth on a birth seat is inconclusive. AIM: The objective of this study was to describe the proportion of genital tract tears in women who gave birth on a birth seat compared to women who did not. METHOD: An observational cohort study based on birth information collected prospectively. In total 10 629 live, singleton, non-instrumental births in cephalic presentation were studied. RESULTS: Fewer women who gave birth on a birth seat experienced an overall intact genital tract compared to women who gave birth in any other position. Women who gave birth on a birth seat were less likely to have an episiotomy performed. Women who gave birth vaginally on a birth seat after a previous caesarean section may have an increased risk for sustaining a sphincter tear. DISCUSSION: It is important to be aware of the decreased chance of an overall intact genital tract area when giving birth on a birth seat. Furthermore, there is a possibly increased risk of sphincter tear in women having a vaginal birth after caesarean. It is required and of importance to provide pregnant women with evidence-based information on factors associated with genital tract tears including birth positions.


Assuntos
Parto Obstétrico/efeitos adversos , Genitália Feminina/lesões , Lacerações/etiologia , Adulto , Cesárea/efeitos adversos , Parto Obstétrico/instrumentação , Episiotomia/estatística & dados numéricos , Feminino , Humanos , Decoração de Interiores e Mobiliário , Apresentação no Trabalho de Parto , Parto/fisiologia , Gravidez , Estudos Prospectivos
20.
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
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