ABSTRACT
A mortalidade materna é inaceitavelmente alta. A hemorragia pós-parto encontra- se na primeira posição no mundo, tendo como principal causa específica a atonia uterina. Eventualmente, as medidas iniciais e a terapia farmacológica não são efetivas no controle do sangramento, impondo a necessidade de tratamentos invasivos, cirúrgicos ou não. Entre esses, o tamponamento uterino com balão requer recursos locais mínimos e não exige treinamento extensivo ou equipamento muito complexo. Entretanto, algumas dificuldades podem ocorrer durante a inserção, infusão ou manutenção do balão na cavidade uterina, com especificidades relacionadas à via de parto. Após o parto vaginal, a dificuldade mais prevalente é o prolapso vaginal do balão. Na cesárea, as principais dificuldades são a inserção e o posicionamento do balão na cavidade uterina, principalmente nas cesáreas eletivas. Este artigo revisa e ilustra as principais dificuldades e especificidades relacionadas ao tamponamento uterino com balões.
Maternal mortality is unacceptably high. Postpartum hemorrhage is ranked first in the world, with the main specific cause being uterine atony. Eventually, initial measures and pharmacological therapy are not effective in controlling bleeding, imposing the need for invasive treatments, surgical or not. Among these, uterine balloon tamponade requires minimal local resources and does not require extensive training or very complex equipment. However, some difficulties may occur during insertion, infusion, or maintenance of the balloon in the uterine cavity, with specificities related to the mode of delivery. After vaginal delivery, the most prevalent difficulty is vaginal balloon prolapse. In cesarean section, the main difficulty is the insertion and positioning of the balloon in the uterine cavity, especially in elective cesarean sections. This article reviews and illustrates the main difficulties and specificities related to uterine balloon tamponade.
Subject(s)
Humans , Female , Pregnancy , Uterine Balloon Tamponade/instrumentation , Cervix Uteri/injuries , Postpartum Hemorrhage/mortality , Natural Childbirth , ObstetricsABSTRACT
Las pacientes infértiles tienen un riesgo aumentado de resultados obstétricos y perinatales adversos que dependen de los factores de infertilidad subyacentes previos y de factores inherentes a los tratamientos recibidos para lograr el embarazo. La edad materna, las patologías previas ginecológicas, hormonales, endocrinológicas, metabólicas y anatomo funcionales son reconocidas como factores de riesgo para resultados adversos obstétricos y perinatales. Los tratamientos como la hiperestimulación ovárica y los tratamientos de reproducción asistida condicionan riesgos adicionales, especialmente por el aumento de embarazos múltiples que se generan con estas terapias. El aumento de la edad materna de pacientes tratadas por infertilidad y la necesidad creciente de tratamientos de reproducción asistida determinan probablemente, un mayor riesgo futuro de complicaciones obstétricas y perinatales. Muchos de estos factores de riesgo pueden ser modificados y manejados antes de iniciar los tratamientos con la finalidad de mejorar el pronóstico para la madre y el recién nacido. La consideración de estos factores de riesgo y sus consecuencias en el embarazo son parte esencial del consejo reproductivo que debiera recibir toda paciente que se somete a tratamientos por infertilidad.El objetivo de esta revisión es mostrar la relación existente entre las pacientes que consultan por infertilidad, los tratamientos usados y los potenciales riesgos obstétricos y perinatales cuando se produce el embarazo.
Infertile patients have an increased risk of adverse obstetric and perinatal outcomes that depend on underlying infertility factors and on those treatments recieved to become pregnant. Maternal age, hormonal, endocrinologial, metabolic and anatomic/functional gynecological diseases are widely recognized risk factors for adverse obstetric and perinatal outcomes. Infertility treatments like controlled ovarian hyperstimulation and assisted reproductive technologies add aditional risks, specially related to multiple pregnancies that are associated to. The higher maternal age of patients seeking for infertility treatment and the increasing need of assisted reproductive technologies probably determines a higher and increasing risk of obstetric and perinatal adverse outcomes. In many cases risk factors can be adequately modified and controlled before treatments are initiated thus improving maternal and neonatal prognosis. This risk factors and their consequences in pregnancy have to be strongly considered in reproductive counselling that should recieve every patient treated for infertility.The aim of this article is to show the relation between infertile patients seeking for treatment and their potential risks of obstetric and perinatal adverse outcomes when they get pregnant.
Subject(s)
Humans , Female , Pregnancy Complications/epidemiology , Reproductive Techniques, Assisted/adverse effects , Infertility/therapy , Polycystic Ovary Syndrome , Pregnancy Complications/etiology , Pregnancy, Multiple , Pregnancy Outcome , Fetal Diseases , Infant, Newborn, DiseasesABSTRACT
Objective To explore the complications and influence of repeat cesarean section after previous cesarean delivery. Methods The styles of the total 67 cases of repeat cesarean section were reviewed, and the mater-nal ages, gestarional weeks, time intervals between the two times of delivery, and the styles of the previous cesarean section were analyzed. Results Of the total 67 case of repeat cesarean section ,there were 8 cases with relatively se-vere adhesion, 1 case with hysterectomy. There were 9 cases with intraoperative blood loss over 500ml(13.4%). The rate of adhesion induced by abdominal transverse incision of cesarean section was significantly higher than that of ab-dominal longitudinal incision of low cesarean section. Conclusions When we determining a style of cesarean section, we should comprehensively consider the obstetrical conditions of the pregnant women to select abdominal incision style and uterine incision style. The quality of previous cesarean delivery determines the complications of repeat cesarean section.
ABSTRACT
Objective We investigated the correlations between abnormal fetal heart rate (FHR) during the second stage of labor and delivery types and intrapartum maternal complications and fetal outcome Methods The data of 232 nulliparas with single vertex in the second stage of labor (111 cases with normal FHR, 121 cases with abnormal FHR) were analyzed retrospectively Results The incidence of abnormal FHR in the second stage of labor was 52 2%(121/232) The patterns of abnormal FHR included: 81 (66 9%) cases with moderate and/or severe variable deceleration (VD), 27 (22 3%) cases with scattered late deceleration (LD), only one with continuous LD, 4 (3 3%) cases prolonged deceleration (PD), 2 (1 7%) cases with VD and LD, 3 (2 5%) cases with VD and PD, 4 (3 3%) cases with diminished baseline variability There were 13 (11 7%) among the cases with normal FHR and 35 (28 9%) among the cases with abnormal FHR underwent assistant delivery operations (forceps or/and vaccum), respectively ( P