Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology
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Review Comparative Study
Perioperative morbidity associated with abdominal myomectomy compared with total abdominal hysterectomy for uterine fibroids.
The aim of the study was to systematically review and summarise existing evidence related to the perioperative morbidity associated with abdominal myomectomy in comparison with abdominal hysterectomy for uterine fibroids. A review of MEDLINE and EMBASE was carried out. The primary outcome was the major morbidity rate and secondary outcomes were uterine size, estimated blood loss, blood transfusion, operating time and duration of hospital stay. ⋯ There was no significant difference in the rate of major morbidity (RR 0.94; 95% CI = 0.31, 2.81; p = 0.91) between the two operations. It was concluded that based on variable quality data from retrospective cohort studies, abdominal myomectomy and hysterectomy appear to have similar major morbidity rates for the uterine size up to 16-18 weeks. Well-designed trials with a standardised morbidity outcome and including uterine size greater than 18 weeks are required.
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Perimortem caesarean section (PCS) is a rare event often resulting in high mortality of mother and/or fetus. It represents a tragedy for the mother and the family and a crisis for the healthcare professionals managing such a case. This paper seeks to raise awareness of the pertinent issues surrounding PCS and challenges care providers to put in place procedures to deal with this catastrophic event. It also reviews the historical perspective of PCS, maternal physiology during cardiopulmonary resuscitation (CPR), prognostic factors for maternal and fetal wellbeing, techniques of PCS, survival for mother and baby and the medico legal aspects of PCS.
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Review Case Reports
The role of recombinant activated Factor VII in major obstetric haemorrhage: the Farnborough experience.
Major obstetric haemorrhage is one of the commonest causes of maternal mortality and morbidity worldwide. It may result in coagulopathy and diffuse pelvic or vaginal bleeding. Correction of coagulopathy when administering Factor VII may be crucial to the management of selected cases. ⋯ Recombinant activated Factor VII is a potential haemostatic agent in massive obstetric haemorrhage. Its successful use has been reported in post-surgical bleeding and consumptive coagulopathy. It may abolish the need for hysterectomy, which has a devastating effect on the patient future fertility and psychological well-being.
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Ante-partum haemorrhage is an important cause of maternal and fetal morbidity and mortality, despite modern improvement in obstetric practice and transfusion service. It is defined as any vaginal bleeding from the 20th week of gestation till delivery. The initial management of ante-partum haemorrhage should concentrate on resuscitation and accurate diagnosis. ⋯ In many cases, it is not possible to make a definite diagnosis, despite all the investigations. Development of ultrasound especially transvaginal scan has helped in the definitive diagnosis and management of placenta praevia. Every unit should have a clear protocol for the management of massive haemorrhage, which should be regularly updated and rehearsed.