Risk factors of retained placenta in Siriraj Hospital.

OBJECTIVE: To identify risk factors associated with retained placenta after vaginal delivery. DESIGN: Case-control study. MATERIAL AND METHOD: Medical records of 234 pregnant women whose gestational age > or =28 weeks were reviewed. Cases comprised of 78 women with retained placenta after vaginal delivery and controls comprised of 156 women with spontaneous placental delivery. Associated risk factors were examined Chi-square test and logistic regression analysis were used for analysis of data. RESULTS: Cases were significantly older than controls (29.3 +/- 6.4 vs. 27.0 +/- 6.4 years respectively, p = 0.01). Cases were likely more significant than controls to have a previous history of uterine curettage (20.5% vs. 6.4% respectively, p = 0.001) and premature rupture of membranes (35.9% vs. 22.4% respectively, p = 0.029). Between the two groups, there were no differences in gestational age, parity, previous abortion, induction of labor, oxytocin, and pethidine usage. Logistic regression analysis showed that independent risk factors for retained placenta were age (adjusted OR 1.06, 95% CI 1.01-1.11), previous uterine curettage (adjusted OR 4.2, 95% CI 1.7-9.9), and PROM (adjusted OR 2.2, 95% CI 1.2-4.1). CONCLUSION: Maternal age, previous uterine curettage, and PROM were independently associated with increased risk of retained placenta. The condition should be aware of among pregnant women with such risk factors.

Oral etoricoxib for pain relief during fractional curettage: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of oral etoricoxib and placebo combined with paracervical block for pain relief during fractional curettage MATERIAL AND METHOD: A double-blind, randomized controlled trial that included 220 women who underwent fractional curettage and received paracervical block for pain relief was done at Ramathibodi Hospital between September 2005 and June 2006. One hundred and ten women were randomly allocated to the etoricoxib group (90 mg, tablet) and 110 to the placebo group. The main outcome was the patient's assessment of intensity of pain measured by verbal rating scales after speculum insertion, during fractional curettage, immediately after curettage, and 30 minutes after curettage. RESULTS: Demographic data including age, previous vaginal deliveries, and history of curettage were not significantly different between etoricoxib group and placebo group. Most common indication for fractional curettage was menometrorrhagia in both groups. Pain score in etoricoxib group was significant lower during fractional curettage (5 vs. 6, p = 0.04), immediately after curettage (2 vs. 3, p = 0. 009), and 30 minutes after curettage (0 vs. 1, p = 0.003). Comparing the number of patients with mild pain (score 0-3), there were significant higher number of mild pain patient at the time during curettage (39 vs. 20 cases), immediate after curettage (78 vs. 60 cases), and 30 minutes after curettage (107 vs. 100 cases) in etoricoxib group. CONCLUSION: Combination of etoricoxib with paracervical block for reduction of pain during fractional curettage had statistically significant lower pain scale when compared with placebo with paracervical block. However the difference was small and may have questionable clinical significance.

Septic induced abortion claiming life of a Nepalese woman.

This is a case report of septic induced abortion done at 16 weeks of gestation outside Kathmandu valley who presented to the emergency department of Tribhuvan University Teaching Hospital (TUTH) with peritonitis and septic shock. The case underwent emergency laparotomy and was treated surgically for perforated ileum and uterus by resection and end to end anastomosis of bowel and subtotal hysterectomy. The patient died after 16 hours of operation due to multiple organ failure (MOF) as a sequelae of septic shock. Unsafe abortion remains one of the major causes of maternal mortality in Nepal. Increasing public awareness about hazards of septic abortion and the provisions of law and decentralizing the trained manpower throughout the country would play a pivotal role in decreasing the incidence of septic induced abortion.

Randomized controlled trial of mefenamic acid vs paracervical block for relief of pain for outpatient uterine curettage.

OBJECTIVE: To compare the efficacy of mefenamic acid vs paracervical block for pain relief during and after fractional curettage. MATERIAL AND METHOD: Between January 1 and July 31, 2002, the authors enrolled 87 patients with abnormal uterine bleeding, who requested fractional curettage at the Outpatient Gynecologic Clinic, Srinagarind Hospital, Khon Kaen University. A simple randomization procedure was used to distribute the patients into a control group comprising 44 patients given a paracervical block and a treatment group comprising 43 patients given mefenamic acid (500 mg) 2 hours before starting the procedure. OUTCOME MEASURES: Pain was scored using a visual analogue scale (VAS range, 0 to 10). RESULTS: The median pain scores of the treatment types during endocervical, endometrial, immediately after, and 30 minutes after, fractional curettage were 2.5 vs 3.0 (p = 0.42), 6.5 vs 7.5 (p = 0.19), 4.0 vs 3.5 (p = 0.20) and 1.5 vs 1.0 (p = 0.17), respectively. The rate of complications was 6.8% (3 in 44) in the paracervical lignocaine injection group. CONCLUSION: The efficacy of pain relief for fractional curettage using oral mefenamic acid (500 mg) two hours before the procedure was not statistically different from the paracervical block, but there were fewer side effects. Mefenamic acid should be considered an alternate pain relief during fractional curettage.

Dexamethasone for the prevention of nausea and vomiting after dilatation and curretage: a randomized controlled trial

Postoperative nausea a and Vomiting [PONV][1] are common complications after surgery. Propofol based nesthesia is a effective technique for decreasing of PONV. Most study are formed to evaluate efficacy of Dexamethasone in preventing of PONV, but there have been no reports to evaluate the efficacy of dexamethasone for preventing PONV in propofol -based anesthesia for D and C[1]. In a prospective, randomized double - masked, placebo controlled trial, 202 women received placebo or dexamethasone intravenously at doses of 4 mg, 8mg,.or 16mg immediately before Induction of anesthesia. Propofol based general anesthesia was used. Emetic episodes and safety assessments were performed to estimate sufficient sample size using chi- squar test with confidence interval 95% [alpha= 0.05 and beta=0.2]. The rate of patients who were emesis free [no nausea or vomiting] 0-24 hours after anesthesia was 78.4 in placebo, 81.1% in dexamethasone 4 mg, 90.0% in dexamethasone 8 mg and 95% in dexamethasone 16 mg. No clinically important adverse events were observed in any of the groups. Dexamethasone 8 mg is an effective antiemetic durg for prevention of postoperative nousea and vomiting 0-24 hours after anesthesia in women undergoing propofol based general anesthesia for termination of pregnancy. Increasing the dose to 16mg provided no additional benefit. In regard to cost, Dexamethasone is prefer to other drugs

Mobius syndrome associated with ventricular septal defect.

We report a 10-year-old boy with Mobius syndrome (MS) associated with ventricular septal defect who was delivered after an unsuccessful curettage before the 10th week of gestation. Methylergobasine which is an ergot alkaloid was also applied during the curettage procedure. Despite of the curettage procedure, the pregnancy was continued and he was delivered. His developmental milestones were delayed. On account of this case, we think that direct mechanical fetal trauma and vasoconstriction or both may cause MS. But, further extensive studies are needed to verify this hypothesis.

Sinéquia intra-uterina: importância e tratamento / Intrauterine adhesions: importancy and treatment

Os autores fazem uma revisão e atualização sobre as sinéquias intra-uterinas (SIUs), enfocando principalmente sua importância atual e o método histeroscópico para o tratamento dessa afecção. Outros enfoques terapêuticos como a histerotomia no tratamento das SIUs totais, limitações do método histeroscópico e eventuais complicações obstétricas subseqüentes à sinequiolise histeroscópica são também discutidos neste trabalho

Estado actual del taponamiento uterino con sonda de Foley en sangrado incoercible / Present states of uterine tamponade with Foley catheter in incoercible bleeding Hospitalary experience in Mexico

Dentro de la obstetricia, el taponamiento uterino se ha usado en el control de la hemorragia, sin embargo, el manejo puede ser difícil recurriendo a manejo radical como la histerectomía. Presentamos cuatro casos de sangrado profusos durante la realización de legrados los cuales no se controlaron con manejo médico convencional y fueron exitosamente tratados con el uso de la sonda de foley la cuál es dejada en cavidad por 12 a 24 horas. No existieron complicaciones atribuibles al método. El taponamiento uterino con sonda de foley es una opción terapéutica útil previo a la realización de trapia radical o ablativa

Right-sided endocarditis following abortion--underdiagnosed condition case report.

We have presented a patient who followed abortion went on to develop septicemia, right-sided endocarditis and septic pulomonary emboil. Such potentially fatal condition should be prevented and diagnosed early to prevent morbidity and mortality.

Enfermedad trofoblástica gestacional en el Hospital Nacional Cayetano Heredia. Aspectos epidemiológicos y clínicos / Gestational trophoblastic disease at the Hospital Cayetano Heredia. Epidemiological and clinical aspects

Con el objetivo de evaluar aspectos clínicos y epidemiológicos, se revisaron 113 historias clínicas de pacientes con Enfermedad Trofoblástica Gestacional (ETG) atendidas en el Departamento De Obstetricia y Ginecología del Hospital Nacional Cayetano Heredia entre Enero de 1981 y Diciembre de 1990se encontró una frecuencia de 2.33 casos de ETG por 1000 embarazos. La frecuencia fue significativamente mayor en las gestantes mayores de 40 años (22.09 por 1000 partos). La ginecorragia fue el signo de presentación más frecuente (90.26 por ciento), seguido por desproporción altura uterina-tiempo de amenorrea (39,82 por ciento) e hiperemesis gravídica (29.20 por ciento). El legrado uterino fue el único tratamiento empleado en el 76.80 por ciento de las pacientes. Se registraron tres casos de coriocarcinoma, en 17 pacientes se registró actividad trofoblástica persistente en el seguimiento post-evacuación, y en cinco se evidenciaros lesiones radiológicas compatibles con metástasis pulmonares. No se encontró asociación entre los factores pronósticos reconocidos en la literatura y la persistencia de actividad trofoblástica en estas pacientes.

Dispositivo intrauterino post-aborto complicaciones en el Hospital Arzobispo Loayza / Intrauterine dispositivce post-abortion, complications in Arzobispo Loayza Hospital

Se realizó un estudio descriptivo-prospectivo sobre el DIU postaborto inmediato en el Hospital Arzobispo Loayza, para evaluar la aceptación y complicaciones tempranas del método. Se seleccionaron 102 pacientes con abortos incompletos. 72 (70.58 por ciento) pacientes aceptaron el DIU postaborto y constituyeron el grupo USUARIAS. Las 30 pacientes restantes constituyeron el grupo NO USUSARIAS. No hubo complicaciones durante el legrado uterino, la inserción del DIU o en el post-operatorio inmediato. Se realizó el seguimiento ambulatorio en ambos grupos, hasta el mes post-legrado. Durante el seguimiento se observó un incremento significativo del dolor abdominal y flujo vaginal anormal en las USUARIAS comparado con las NO USUARIAS. Se encontró 4 casos (6.4 por ciento) con enfermedad pélvica inflamatoria (EPI) en las USUARIAS y 1 caso (5.3 por ciento) en las NO USUARIAS. Se concluye que hay buena aceptación del DIU postaborto inmediatop siendo su inserción segura y, que no se encontró diferencia significativa en la prevalencia de EPI entre ambos grupos.

Acute abdomen a complication of uterine intervention

A prospective evaluation of 19 patients of complicated abortion presenting in the general surgical emergency over a period of four and a half years is presented. The mean age of the patients was 25.4 years. Presenting complaints included acute abdominal pain, vomiting, abdominal distension and absolute constipation in all cases. 16 patients were married and 3 unmarried. Tachycardia, pyrexia, generalised abdominal tenderness, guarding and absent bowel sound were present in all cases. Free gas under the diaphragm was present in 11 patients and multiple air fluid level in 8 patients. 13 out of 19 patients had intestinal injury [10 small gut and 3 colon]. 7 patients had external evidence of intestinal injury. Fundus of the uterus and posterior fornix were the common sites of perforations. Fundal perforations were repaired. Hysterectomy was carried out when the perforation involved the fornixes and major vessels and in those patients who pre-operatively asked for it. In six patients resection and anastomosis for small gut injury was carried out where as in four patients perforations were repaired. In 3 patients with colonic injury, resections and anastomosis of the injured colon along with transverse colostomy were carried out. There were two deaths in this series. The incidence of post operative complications was low. Mean hospital stay remained 8 days. Emergency surgeon dealing with general surgical emergencies should keep this possibility in mind if patient gives history of D and C and features of acute abdomen

Avaliaçäo de diferentes técnicas de esvaziamento uterino como fator de risco para neoplasia trofoblástica invasora e metastática / Evaluation of different technics of uterine evacuation as a risk factor for invasive and metastatic trophoblastic neoplasms

Avaliou-se a influência da forma de esvaziamento uterino: curetagem ou vacuoaspiraçäo e do uso de ocitócico sobre a incidência de neoplasia trofoblástica gestacional invasora/metastática entre pacientes com diagnóstico de abortamento molar. O estudo inclui 42 pacientes com diagnóstico histopatológico de mola hidatiforme completa benigna e com altura uterina superior a 12cm. Vinte e cinco casos foram esvaziados por curetagem uterinas e 17 por vacuoaspiraçäo. Do mesmo grupo de 42 pacientes, 27 receberam ocitocina para promover a dilataçäo do colo uterino e/ou expulsäo parcial da mola e 15 näo foram tratadas com ocitócico. A análise estatística mostrou que o uso de ocitócico prévio ao esvaziamento uterino é fator agravante do risco de evoluçä para neoplasia invasora, particularmente se associada a curetagem uterina