[Neonatal outcome after a planned vaginal breech birth: no association with parity or birth weight, but more birth injuries than in planned cesarean section]. / Neonatale uitkomst na een in opzet vaginale bevalling bij aterme stuitligging: geen verband met pariteit of geboortegewicht, maar wel meer geboorteletsels dan bij primaire keizersnede.

OBJECTIVE: To investigate if in a planned vaginal breech delivery parity or birthweight is associated with neonatal outcome. DESIGN: Retrospective analysis of local data from the National Obstetric Registration of the Netherlands. METHOD: The study concerned outcomes of 516 births of singletons with breech presentation after pregnancies > 37 weeks in the period 1 January 1995 to 31 December 1999 at the Medical Centre Leeuwarden, the Netherlands; there were 448 planned vaginal breech deliveries. Nulliparous and multiparous were separately studied in four birthweight groups (< 3000 g, 3000-3499 g, 3500-3999 g and > or = 4000 g). RESULTS: None of the neonates born by primary caesarean experienced birth trauma. In the group with planned vaginal breech delivery 2% of the neonates of nulliparous and 3% of multiparous mothers experienced neonatal morbidity. There was one case of perinatal mortality due to birth trauma (0.2%). The total perinatal morbidity was 6% with no differences between nulliparae and multiparae and between the birthweight groups. In nulliparous, the percentage of emergency caesarean sections rose from 20% in the < 3000 g birthweight group to 62% in the > or = 4000 g birthweight group. CONCLUSION: Following a planned vaginal breech delivery, no differences were observed in neonatal outcome between nulliparous and multiparous women and between the four birthweight groups. The extent to which the figures were influenced by the selection for primary caesarean section is not clear.

Comparison of the modified Pereyra procedure using permanent suture material and Burch urethropexy.

OBJECTIVE: To evaluate the results of the modified Pereyra procedure, using permanent suture, and Burch urethropexy. STUDY DESIGN: In 49 women undergoing modified Pereyra procedure and 48 women undergoing Burch urethropexy between January 1990 and January 1996 results were evaluated using questionnaire based outcomes analysis. RESULTS: Follow up of all women undergoing needle suspension and Burch urethropexy showed that patient satisfaction was achieved in 86% and 81% respectively. Complete cure was achieved in 65% and 63% respectively. CONCLUSIONS: Patient satisfaction in both procedures appeared not totally dependent on the presence or absence of complete cure. The study supports the hypothesis that the modified Pereyra needle suspension using permanent suture is well suited for the treatment of uncomplicated stress urinary incontinence, when compared to Burch urethropexy after a follow up of 1 to 6 years. The results support the impression that permanent suture should be used in the modified Pereyra procedure.

[Less medicalization of obstetrics in West Frisian islands than on the mainland]. / Minder medicalisering van de verloskunde op de Friese waddeneilanden dan op het vasteland.

OBJECTIVE: To inventory the functioning and the results of obstetrics in the West-Frisian islands in 1995 and 1996. DESIGN: Retrospective. METHOD: With enquiry forms information was gathered from the six GP practices in the West Frisian islands concerning the course and results of every pregnancy with a delivery between 1 January 1995 and 31 December 1996. Of emergency transfers during labour and in the postpartum period the time span between moment of applying for a transport and arrival at the hospital ashore was noted. Results were compared with those for the total province of Friesland and the national Dutch results. RESULTS: Of the 253 women 23 (9%) had a primary indication for hospital delivery under care of a gynaecologist. During pregnancy 52 patients (21%) were directed for hospital delivery. 23 (9%) of the 178 patients awaiting the home delivery were referred during labour and 155 women (61%) delivered at home. After delivery 3 patients were admitted. The median time span in emergency transfers was 77.5 min (range: 60-105) with transport by boat and 65 min (55-120) with transport by heli. The island people delivered at home in 61% compared with 37% in Friesland in 1996 and 31% in the Netherlands in 1993, had a hospital delivery under care of a gynaecologist in 39% compared with 56% in Friesland and 58% in the Netherlands in 1996, had a caesarean section in 6% compared with 10% in Friesland and the Netherlands in 1996. There were two foetal mortalities and one neonatal mortality. CONCLUSION: In comparison with the national data the island obstetrics is characterized by a higher home delivery rate, less specialist involvement and a lower caesarean section rate.

Vaginal delivery after previous caesarean section for failure of second stage of labour.

OBJECTIVE: To determine the outcome of subsequent labour in primiparous women after a caesarean section for delay in descent in the second stage of labour in cephalic presentations with or without trial of instrumental vaginal delivery. DESIGN: Retrospective follow up study. SETTING: Medical Centre Leeuwarden, The Netherlands. PARTICIPANTS: All primiparous parturients who delivered after prior caesarean section during the second stage of labour in the period 19861998. METHODS: Data concerning the outcome of the first subsequent delivery were gathered from delivery notes and patients charts. The group of women was subdivided into those with or without trial of instrumental vaginal delivery during the previous labour. RESULTS: Of 132 women, 29 (22%) underwent a planned repeat caesarean section. Of the 103 women who were allowed a trial of labour, 82 (80%) were successful in having a vaginal delivery, and 21 (20%) had a second caesarean section. Of the 74 women with a failed trial of instrumental delivery during the previous labour, 19 had a planned repeat caesarean section and 41 of the remaining 55 (75%) had a successful trial of labour. CONCLUSIONS: In women with a cephalic presentation who had an arrest of descent in the second stage of labour during their first delivery, the chances of vaginal delivery in their next pregnancy are high, even after a failed instrumented vaginal delivery, and a trial of labour can usually be pursued.

Single dose ceftriaxone versus single dose cefuroxime plus metronidazole for preventing febrile morbidity and urinary tract infection in vaginal hysterectomy.

OBJECTIVE: To compare the prophylactic efficacy of 1 g ceftriaxone with 1.5 g cefuroxime + 0.5 g metronidazole for febrile morbidity and urinary tract infection in patients undergoing vaginal hysterectomy. STUDY DESIGN: A prospective, randomized, comparative, non-blinded study with at least 100 patients on each side. The two-sample t-test was used for testing equality of two means and the chi 2 test was used for pair differences. RESULTS: Single dose cefuroxime + metronidazole and ceftriaxone were equally effective in preventing febrile morbidity postoperatively. Additionally ceftriaxone was more effective in sterilizing pre-operatively existing bacteriuria.

An extra gonadal non-gestational choriocarcinoma in a woman treated for an endometrial carcinoma.

A patient was presented with a non-gestational non-gonadal choriocarcinoma and hyperthyroidism. Five years earlier, at the age of 36, she underwent an abdominal hysterectomy with bilateral adnexectomy for endometrial carcinoma. Despite intensive treatment with multiple chemotherapy the patient died. We concluded that this non-gestational, non-gonadal choriocarcinoma was a recurrence of her previous endometrial carcinoma or a new extra (non) gonadal germcell tumor with choriocarcinoma.

Antibiotic prophylaxis in vaginal hysterectomy. Three doses of cefuroxime plus metronidazole versus one dose of ciprofloxacin.

The prophylactic efficacy of three intravenous doses of cefuroxime 1,500 mg plus metronidazole 500 mg in vaginal hysterectomy was compared with placebo in a prospective double-blind randomized study. Febrile morbidity occurred in 13 of 26 patients in the placebo group and 0 of 27 patients in the study group. In a second prospective randomized study, the efficacy of intravenous ciprofloxacin (200 mg single dose) was compared with the cefuroxime plus metronidazole regimen. Febrile morbidity was found in 3 of 54 patients in the ciprofloxacin group, but in none of the 58 patients in the cefuroxime plus metronidazole group.