Pregnancy in renal transplantation.

UNLABELLED: Pregnancy in kidney transplantation is, considering its numerous complications, listed in category of high-risk pregnancies. Complications occur as consequence of action of immunosuppressant drugs and mutual interactions of graft on pregnancy and pregnancy on graft. To asses conception it is necessary for female patient to fulfill conditions after which planning and management of pregnancy are carried out. Planning means a list of actions which altogether have as a goal to decrease risk factors for future mothers and for babies as much as possible. Pregnancy management is also procedural, including numerous hospitalizations, in which pregnancy, fetus and renal function are controlled, on-time identifying potentially dangerous complications and solving ones that might have already occurred. With all given precautions there is still no guarantee for successful pregnancy termination, although given measurements significantly improve possibilities of normal childbirth, like those in general population. KEYWORDS: renal transplantation, pregnancy.

The Misgav-Ladach method of cesarean section: a step forward in operative technique in obstetrics.

OBJECTIVE: The objective of this study is to compare the intraoperative and short-term outcomes of two cesarean techniques: the modified Misgav-Ladach and the Pfannenstiel-Kerr. METHODS: We performed a prospective observational cohort study of women undergoing a primary cesarean at the Clinic for Obstetric and Gynecology Tuzla, Bosnia and Herzegovina, between January 2003 and December 2011. The two cesarean techniques were compared for intraoperative and short terms outcomes. RESULTS: A total of 4,944 women were included in this study, 4,336 allocated to the modified Misgav-Ladach and 608 to the Pfannenstiel-Kerr techniques. The rate of modified Misgav-Ladach increased from 74 % in 2003 to 99 % in 2011. The modified Misgav-Ladach technique was associated with a shorter operative time (13.3 min ± 7.4 vs. 19.1 min ± 6.8, p < 0.05), as well as significantly less surgical material (3.5 ± 2.5 vs. 7.9 ± 2.1, p < 0.05). The modified Misgav-Ladach technique was also associated with lower analgesic requirements, lower rates of febrile morbidity and wound infection compared to the Pfannenstiel-Kerr technique (p < 0.05). No significant differences were observed in the incidence of endometritis, wound dehiscence, bowel restitution, postoperative antibiotic use, and hospital stay. CONCLUSION: The modified Misgav-Ladach technique is associated with a shorter operative time than Pfannenstiel-Kerr and might lead to better postoperative outcomes.

Short-term postnatal quality of life in women with previous Misgav Ladach caesarean section compared to Pfannenstiel-Dorffler caesarean section method.

OBJECTIVE: To examine whether short-term postnatal health-related quality of life differed among women after different methods of cesarean sections. METHODS: One hundred forty-five women were evaluated with previous CS (85 by Misgav Ladach and 60 by Pfannenstiel-Dörffler). Short-time quality of life was measured using the Croatian version of Short Form Health Survey (SF - 36). Short-term postoperative recovery was assessed using two criteria: febrile morbidity and degree of pain. Incidence of peritoneal adhesions was assigned using Bristow scoring system. RESULTS: Four weeks after delivery women with previous Misgav Ladach cesarean section significantly scored higher on the bodily pain (72.4 vs. 56.7, p < 0.05), social functioning (71.5 vs. 60.4, p < 0.05), and the vitality (61.7 vs. 50.3, p < 0.05) subscales. These differences disappeared in the second assessment (12-weeks postpartum) except in the bodily pain (74.7 vs. 61.2, p < 0.05) subscale. There was a significant trend toward a higher requirement for postoperative analgesics in the Pfannenstiel-Dörfler group (doses: 5.4 vs. 8.7, p < 0.05; hours: 17.9 vs. 23.3, p < 0.05), and they had a significantly higher rate of febrile morbidity than the Misgav Ladach group (5.7 vs. 9.4%, p < 0.05). Hospitalization time was reduced in the Misgav Ladach group (4.2 vs. 7.3, p <\ 0.05). The incidence of adhesions was significantly lower in patients who had undergone a previous operation using the original Misgav Ladach method (0.47 vs. 0.77, p < 0.05). CONCLUSION: Misgav Ladach cesarean section method might lead to better short-time quality of life resulting in reducing postoperative complications compared to Pfannenstiel-Dörfler cesarean section method.