ABSTRACT
Objective: The objective of this study is to compare the outcomes of standard cesarean section uterine closure, single-layered running lock sutures, versus using primary horizontal mattress sutures (the K uterine closure technique). Method: This study used a retrospective cohort chart review of patients undergoing elective primary and repeat cesarean section between January 2016 and August 2020 at a South Florida hospital. From 613 included patients, 176 received the K uterine closure technique completed by a triple board-certified physician. Remaining 437 patients received single-layered lock uterine closure completed by other physicians in the same hospital. Clinical, demographic, and post-operative outcomes were collected using patients' operative, post-operative, and progress notes. Results: Using the data gathered, the experimental group demonstrated a greater difference between pre- and post-cesarean section hemoglobin (p < 0.027) and hematocrit (p < 0.014) compared to single-layered lock closure methods. There was a significantly lower estimated blood loss (p < 0.001), however, there was no significant difference in the average quantitative blood loss (p < 0.374). There was also a significant reduction in the length of total and postoperative hospital stay (p < 0.001), but the total operation time was significantly increased (p < 0.016). No significant difference was found in the percentage of patients using opioids as pain management during hospital stay (p < 0.431). There was no need for blood transfusion nor an increase in infectious morbidity using this method. Conclusions: Using the K uterine closure technique for post-cesarean section uterine closure was a reasonable alternative for closure of hysterotomy. It led to decreased duration of hospital stay and no significant difference in quantitative blood loss. The greater difference in hemoglobin and hematocrit for the K uterine closure technique group could be explained due to the significantly greater total operation time. Although the single-layered running lock suture closure is what has been more historically performed by obstetricians for cesarean sections, this data supports the viability and efficacy of the K uterine closure technique as an equally safe, non-inferior alternative. The value of this technique for uterine closure can be confirmed with future prospective studies and potential research in reduction of uterine scar defects. Synopsis: Primary horizontal mattress closure at cesarean section provides a safe alternative to single-layered lock closure and may reduce blood loss, hospital stay, and opioid use.
ABSTRACT
This report describes the clinical presentation and systematic workup of a 25-year-old primigravid woman presenting at 34 weeks gestation with symptoms of postprandial sinus tachycardia. Differentials included pregnancy-related inappropriate sinus tachycardia (PRIST) and swallowing-induced atrial tachycardia. PRIST has favorable outcomes for both the mother and baby, although the symptoms can be distressing and lead to the overutilization of healthcare resources. The literature describes symptom onset as sporadic with no definitive triggers, often occurring in the later trimesters of pregnancy. Swallowing-induced atrial tachycardia, which fits with postprandial symptoms seen in this patient, is a distinct entity most commonly diagnosed in middle-aged men. Management included psychosocial support and pharmacologic treatment with labetalol. The patient's course was benign with an uncomplicated delivery at 38 weeks, complete resolution of symptoms in the postpartum period, and successful discontinuation of pharmacologic management with no relapses. Current literature on postprandial sinus tachycardia in pregnant women is limited, and the best treatment method is unknown. This report extends current knowledge on pregnancy-related postprandial sinus tachycardia and provides a framework for advances in the management of this clinical presentation.
ABSTRACT
Congenital unilateral agenesis of the ovary and fallopian tube is a rare condition that has been previously described in the literature. While this condition is benign, studies have proposed it could be associated with infertility. The purpose of this report is first to highlight a rare incidental finding of unilateral ovarian and fallopian tube agenesis. Secondly, we aim to discuss the various imaging modalities used for the detection of uterine, ovarian, and fallopian tube defects and their shortcomings. Our case describes a 37-year-old G4P0030 woman with an obstetric history of spontaneous abortion and ectopic pregnancy, presenting at 38 weeks gestational age with polyhydramnios. The patient received routine obstetric care with no abnormalities being reported on routine ultrasonography. Elective cesarean section was performed at which time the incidental condition discovery of unilateral agenesis of the right ovary and fallopian tube was made. This case is unique since the incidental diagnosis of unilateral right ovarian and right fallopian tube agenesis occurred during cesarean delivery instead of through imaging. It is important for patient counseling to understand the typical workup and deficiencies in pelvic imaging concerning congenital anomalies.
ABSTRACT
Sudden sensorineural hearing loss (SSNHL) can manifest in pregnancy, but very few cases of SSNHL in pregnancy have been reported and none has been reported in the United States. Additionally, there are no established guidelines for how to treat SSNHL in pregnancy. The purpose of this report is to describe how SSNHL presents in pregnancy, to evaluate other etiologies and discuss current treatment options. A 35-year-old parous woman at 22 weeks of gestation, with a 2-week history of left-sided hearing loss, was shown to have a speech recognition threshold of 70 dB in her left ear. Otolaryngology confirmed the diagnosis of SSNHL. The patient was prescribed an oral prednisone taper that helped alleviate the hearing loss. She had an uncomplicated delivery and treatment with corticosteroids had no adverse consequences for the patient. After ruling out etiologies of SSNHL, corticosteroids may be used safely and efficaciously to treat SSNHL during the second trimester of pregnancy.
ABSTRACT
The incidence of abnormal placentation has escalated due to the increase in cesarean sections. Adherent placentas are associated with significant maternal morbidity and mortality and often result in cesarean hysterectomy due to life-threatening hemorrhage. The purpose of these case reports is to describe conservative management of placenta accreta by utilizing a helium plasma device to fulgurate the placental bed. Placenta accreta is associated with a 7% mortality rate and 60% morbidity rate. Conservative treatment for uterine preservation include embolization, placenta left in-situ, uterine balloon tamponade, and methotrexate. Complications of these options include hemorrhage, endometritis, and morbidly adherent placentas (MAP) recurrence in subsequent pregnancies. The helium plasma device utilizes radiofrequency (RF) to ionize helium into a plasma beam capable of coagulating and fulgurating tissue with high precision and minimal thermal spread. This instrument is Food and Drug Administration (FDA) approved for surgical coagulation and fulguration, but has not been evaluated in the treatment of placenta accreta at the time of a cesarean section. The helium plasma device was used to fulgurate the placenta accreta at 40% power 4 L/min gas flow for 30 seconds, providing adequate hemostasis to the 12.76 cc of retained placental bed. Estimated blood loss was 560 cc. The patient remained hemodynamically stable and had no complications at follow up. The device provided efficient management of placenta accreta. This approach offers a safer alternative management of abnormal placentation and avoiding a cesarean hysterectomy. This novel surgical technique allows women with morbidly adherent placentas to maintain reproductive capability.
