Best practice & research. Clinical obstetrics & gynaecology
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Best Pract Res Clin Obstet Gynaecol · Aug 2013
ReviewThe recurring problem of retained swabs and instruments.
Patient safety is one of the most pressing challenges in health care. The promotion of safety requires that all those involved in healthcare realise that the potential for errors exists, and that teamwork and communication are essential for preventing errors. Incidents compromising patient safety, such as unintended retention of swabs or instruments, are regarded as 'never events'. ⋯ One estimate says that one case of a retained item occurs at least once a year in a major hospital where 8000 to 18,000 major cases are carried out each year. All healthcare organisations should take appropriate measures to prevent retention of foreign bodies by consistent application of reliable and standardised processes of care. In this review, we explore the risks and complications associated with retained swabs and instruments, and different ways to prevent such risks to patients.
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The introduction of in-vitro fertilisation within reproductive medicine has prompted questions to be asked about the relevance of reproductive surgery. Reproductive surgery is more than a competing discipline; it is complementary to the techniques of in-vitro fertilisation. ⋯ The place of reproductive surgery and the existing controversies in the treatment of uterine congenital and acquired pathology, tubal, and ovarian surgery are discussed. Continuous training and accreditation programmes for reproductive technologies and surgery are more important than ever.
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Best Pract Res Clin Obstet Gynaecol · Apr 2013
ReviewSurgical techniques for performing caesarean section including CS at full dilatation.
Caesarean section (CS) is probably the most commonly performed procedure in obstetrics. Over the past two decades, caesarean delivery has become more commonly used throughout the world, and this increase has generated a number of controversial issues, including what constitutes a suitable indication and what is the proper surgical technique to perform a CS. Many aspects of the operation as it is commonly performed today are not based on randomised trials or techniques that have been proven to be superior by rigorous study, but instead are the culmination of many years of trial and error. This chapter presents the evidence on surgical techniques for performing CS, including CS at full dilatation.
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Best Pract Res Clin Obstet Gynaecol · Apr 2013
ReviewTiming of caesarean section according to urgency.
Fetal distress is an emergency condition requiring rapid caesarean delivery. Hence, it has been recommended that the decision-to-delivery interval should be within 30 mins. Many previous studies have failed to show any improved outcome with short decision-to-delivery interval. ⋯ This result supports that every obstetric unit should have the capability to accomplish emergency caesarean section in 30 mins of decision for fetal safety. The Royal College of Obstetrics and Gynaecology has standardised the classification of the urgency of caesarean delivery, which helps to identify those life-threatening fetal conditions that will be benefited from rapid delivery. Training in teamwork and communication, availability of anaesthetists, and operation theatre are the main factors to achieve a quick caesarean delivery.
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Best Pract Res Clin Obstet Gynaecol · Apr 2013
ReviewPostpartum haemorrhage associated with caesarean section and caesarean hysterectomy.
Excessive haemorrhage associated with caesarean section, commonly defined as blood loss in excess of 1000 ml, is frequently underestimated, but is documented as occurring in more than 5-10% of caesarean sections. Common causes are uterine atony, abnormal placentation, uterine trauma and sepsis. It is a major cause of maternal morbidity globally and of maternal mortality in low- and middle-income countries; however, many reports do not disaggregate it from postpartum haemorrhage in general. ⋯ Caesarean hysterectomy is indicated when medical and conservative surgical measures are unsuccessful, and as first-line surgery for extensive uterine rupture and bleeding from morbidly adherent placentae. It has an incidence ranging from 1-4 per 1000 caesarean sections, significantly greater than that for vaginal delivery. Although it is a life-saving procedure, it is associated with significant morbidity, including massive blood transfusion and intensive care (10-48%), urological injury (8%) and the need for relook laparotomy (8-18%).