Emergency cervical cerclage: A review of 15 cases.

BACKGROUND: This report describes our experience with 15 consecutive emergency cervical cerclages performed at Al Yamamah Hospital. PATIENTS AND METHODS: Between February 1994 and February 1997, 15 women with singleton pregnancies between 18 and 26 weeksâ gestation, with a cervical dilatation between 3 and 10 cm and with membrane prolapse, underwent emergency cerclage after excluding labor, placental abruption and intrauterine infection. The membranes were replaced using the technique of overfilling the urinary bladder and then performing McDonaldâs cerclage. All the patients received prophylactic antibiotics and tocolytics. RESULTS: Of the 15 pregnancies, two aborted and 13 ended in live births. Nine of the live births survived, giving a survival rate of 60%. The mean extension of pregnancy in the survivors was 11.5 weeks (range 7.6-15.2 weeks), and the gestational age at delivery ranged from 30-38+ weeks. In six of the patients, suture failed to prolong the pregnancy long enough to produce a âtake-home baby.â All the failures were due to subclinical intrauterine infection. There was no maternal morbidity. CONCLUSION: Emergency cerclage should be considered as a management option in women with painless cervical dilatation and membrane prolapse in the midtrimester.

Early oral intake after caesarean section performed under general anaesthesia.

This study assesses the outcome and benefits of initiation of oral intake 4 hours after caesarean section done under general anaesthesia. After uncomplicated sections, 207 healthy women were alternately assigned either to start oral intake 4 hours after operation, with concurrent stoppage of infusions (n = 106) or to receive 'standard'postoperative care (n = 101). Early oral intake was not associated with increase in gastrointestinal morbidity. Compared with the control group the early intake group had a shorter mean time to first flatus and to first bowel evacuation; initiated breast feeding earlier; ambulated more and were more satisfied. Both groups had similar urine output in the first 24 hours. The nurse's work load decreased when they looked after the early intake group. It is concluded that post-caesarean mothers could be adequately hydrated orally after discontinuing infusions in the early postoperative period without apparent harm and with benefit.

Selective tracheal suctioning to prevent meconium aspiration syndrome.

OBJECTIVE: To analyze the incidence and outcome of meconium aspiration syndrome (MAS) at Al-Yamamah Hospital, Riyadh, Saudi Arabia, where meconium-stained babies have intrapartum obstetrical cleansing of the upper airways, following which depressed/asphyxiated babies are intubated and vigorous babies are observed for 24 h. METHOD: The total live births, records of meconium-stained neonates who had intubations and of those observed, during a 6-year period were reviewed. RESULTS: During this period, there were 85562 live births. One in 325 births (0.27%) was complicated by MAS and the mortality rate was 7%. These figures concur with the reported incidence and mortality of MAS following routine combined obstetric-pediatric suction of airways at birth. Of the 265 cases of MAS that occurred during this period, 237 were in the intubated group and 28 in the observed group. The babies of the former group had severe disease compared with that of the latter. All mortality was from the intubated group. CONCLUSION: Adequate obstetrical cleansing of the upper airway in vigorous babies may obviate the need for endotracheal intubation; intubation of depressed babies following this treatment may be useful.