RESUMO
A randomized clinical study was designed to test the relative efficacy of preinduction cervical ripening with 0.25 mg prostaglandin E2 (PGE2), repeated if necessary (group 1) compared to a single maturation with 0.50 mg PGE2 (group 2). In group 1 (n = 42), the ripening process was repeated every day until spontaneous onset of labor occurred or induction with oxytocin was decided (for improved Bishop score above 5, or maternal or fetal distress). In group 2 (n = 42) the patients who had not labored 12 h after the maturation procedure had labor induced with oxytocin, irrespective of their cervical status. In group 1, 28 patients experienced repeated maturations (from 2 to 9). Thirty patients had an induction of labor with oxytocin in group 2 and only 12 in group 1 (P < 0.0001). There were four failures of induction of labor in group 2 and none in group 1 (P < 0.05). Three episodes of myometrial hyperstimulation requiring an emergency cesarean section for acute fetal distress occurred in group 2 and none in group 1. There were 13 cesarean sections in group 2 and eight in group 1. The outcome of pregnancy was otherwise similar in both groups. In order to avoid failure of induction of labor, pre-induction cervical ripening with 0.25 mg PGE2, repeated daily if necessary, is therefore recommended in high risk pregnancy unless a severe maternal or a fetal distress call for a prompt delivery irrespective of the cervical status.
Assuntos
Colo do Útero/efeitos dos fármacos , Dinoprostona/administração & dosagem , Trabalho de Parto Induzido , Adulto , Esquema de Medicação , Feminino , Humanos , Gravidez , Resultado da Gravidez , Fatores de RiscoRESUMO
The usefulness of pelvic ultrasound in the diagnosis of Rokitansky-Kuster-Hauser syndrome was evaluated retrospectively in 44 patients. Ultrasonography confirmed the diagnosis in 32%, however was wrong in 68% as a uterus was found, though generally described as hypoplasic. The reasons for the low sensitivity of ultrasonography are discussed.
Assuntos
Anormalidades Múltiplas/diagnóstico por imagem , Útero/anormalidades , Vagina/anormalidades , Anormalidades Múltiplas/embriologia , Anormalidades Múltiplas/patologia , Anormalidades Múltiplas/cirurgia , Feminino , Humanos , Histeroscopia , Estudos Retrospectivos , Sensibilidade e Especificidade , Síndrome , UltrassonografiaRESUMO
Surgical coelioscopy has become a regularly used technique for the treatment of benign cysts of the annexes. Complete exeresis and certain histological diagnosis are assured and the postoperative period is simpler than after laparotomy. The risk of pelvic adherences is reduced. We performed coeliosurgery via the transparietal or intraperitonial method in a series of 70 patients for 85 resections of cysts, ovaries or annexes. Length of hospitalization was short and complications were rare. Despite convincing clinical explorations including echography and coelioscopy, we observed one border line tumour and one stage I serous cystadenocarcinoma at histological examination after coeliosurgery. The two observations led us to question percoelioscopic treatment cysts of the annexes but also emphasize the need for careful preoperative work-up and peroperative technique. The indication for laparotomy should be seriously considered in doubtful cases.
Assuntos
Laparoscopia/métodos , Cistos Ovarianos/cirurgia , Ovariectomia/métodos , Adulto , Feminino , Seguimentos , Humanos , Tempo de Internação/estatística & dados numéricos , Menopausa , Pessoa de Meia-Idade , Cistos Ovarianos/diagnóstico , Cistos Ovarianos/epidemiologia , Cistos Ovarianos/patologiaAssuntos
Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Resultado da Gravidez/epidemiologia , Vagina/anormalidades , Adolescente , Adulto , Idoso , Anormalidades Congênitas/classificação , Anormalidades Congênitas/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Complicações na Gravidez/epidemiologia , Prognóstico , Estudos Retrospectivos , Vagina/cirurgiaRESUMO
Various organic lesions can give rise to superficial dyspareunia. Easily surgically treated, they must be recognised: 1) minor hymenal abnormalities: cribriform, microperforate, septate, fleshy or hyperelastic hymens; 2) vaginal abnormalities: longitudinal or transverse septum; 3) post obstetrical or post operative vulvar outlet stenosis; 4) sexual trauma: tears of the vestibular fossa or hymenal tears; 5) stenosing lichen sclerosus, lichen planus, bowenoid papulosis and Bowen's disease; 6) focal vestibulitis associated with more or less obvious psychological outcomes.
Assuntos
Dispareunia/etiologia , Hímen/anormalidades , Vagina/anormalidades , Doenças da Vulva/cirurgia , Anormalidades Congênitas/cirurgia , Feminino , Humanos , Hímen/lesões , Vagina/lesões , Doenças da Vulva/complicações , Ferimentos e Lesões/cirurgiaRESUMO
An attempt was made to ripen the uterine cervix in 100 high-risk pregnancy patients (pregnancy between 34 to 41 weeks' gestation), with the use of intracervical instillations of 0.25 mg of prostaglandin E2 mixed with a tylose gel. The maturation process was repeated every 48 hours. Forty-nine patients were delivered of infants after the first maturation and 51 patients required between two and nine instillations. In patients requiring multiple instillations, the mean delay between the first procedure and delivery was 9 +/- 4 days (range, 2.4 to 16 days). Among the 59 nulliparous women, only 23 were delivered of infants after a single maturation and 36 required multiple maturations (p less than 0.02). When the group of patients who were delivered of infants after a single maturation process was compared with the group requiring multiple maturations, no difference could be seen with regard to age, term of pregnancy, or Bishop cervical score at the time of inclusion in the study. The myometrial activity and the onset labor induced by prostaglandin E2, were similar in both groups. Fetal heart rate decelerations occurred in 16.3% (8/49) of the patients with single maturations and in 17.6% (9/51) of the patients who required multiple maturations. The outcome of the pregnancy and the rate of cesarean sections (24% and 27%) were similar in both groups. No patients required cesarean sections because of failed induction of labor. Cervical ripening after repeated applications of 0.25 mg of prostaglandin E2 seems to be safe for the fetus, providing that the patient is closely supervised.
Assuntos
Colo do Útero/efeitos dos fármacos , Dinoprostona/administração & dosagem , Trabalho de Parto Induzido/métodos , Colo do Útero/fisiologia , Dinoprostona/farmacologia , Feminino , Géis , Frequência Cardíaca Fetal/efeitos dos fármacos , Humanos , Miométrio/efeitos dos fármacos , Paridade , GravidezRESUMO
Lupus anticoagulant, anticardiolipin, antinuclear, anti-deoxyribonucleic acid, antithyroglobulin, and antithyroid microsomal antibodies were assayed during third-trimester pregnancy (100 normal, 100 with complications). In spite of a normal activated partial thromboplastin time in all instances, lupus anticoagulant was further investigated by three additional procedures: tissue thromboplastin inhibition time, platelet neutralization procedure, and cephalin neutralization test. The prevalence of autoantibodies in pregnancies with hypertension reaches 16% (four with lupus anticoagulant, two with anticardiolipin, and two with antithyroid microsomal antibodies), which is significantly greater than that for idiopathic fetal growth retardation (2%) (one with lupus anticoagulant antibodies) and normal pregnancies (3%) (two with antithyroglobulin and one with autithyroid microsomal antibodies) (p less than 0.01). Autoantibodies were equally distributed between patients with gestational hypertension and those with preeclampsia. When compared with the 42 patients with hypertension and no autoantibodies, the eight patients with autoantibody had a more frequent history of fetal growth retardation (p less than 0.05), but there was no difference in the severity of hypertension, the frequency of obstetric complications, or the outcome of pregnancy. They did not require any specific treatment.