Abdomen agudo en la embarazada / The acute abdomen during pregnancy

El abdomen agudo en la embarazada constituye uno de los problemas diagnósticos más difíciles para los obstetras y cirujanos, debido a los cambios anatómicos y fisiológicos que se producen durante la gestación. La presentación de múltiples patologías no tienen la misma intensidad en los síntomas con que se presentan normalmente y la presencia de náuseas y vómitos, común en la mayoría de ellas, pueden aparecer en una gestante sin abdomen agudo aumentando la confusión. Por ello es necesario conocer los cambios fisiológicos de la embarazada y tener en cuenta que cualquier patología que se pueda presentar en una mujer de edad fértil también la puede presentar una embarazada, siendo importante un diagnóstico y tratamiento precoz para evitar un aumento de la morbimortalidad materno-fetal

Acute abdomen in pregnant women constitutes one of the most difficult diagnoses, as much for obstetricians as for surgeons, due to the anatomical and physiological changes that take place during gestation. The presentation of multiple pathologies does not have the same symptom intensity as it usually does, and the presence of nausea and vomiting, common in most pregnancies, can appear without acute abdomen, which tends to increase the confusion. This is why it is necessary to know the physiological changes of the pregnant woman and to keep in mind that any pathology that can present in a woman of fertile age can also present in a pregnant one. Diagnosis and early treatment are important in order to avoid an increase of morbidity and maternal-fetal mortality

[Effect of birth interval on the rate of cesarean section for the second twin after vaginal delivery of the first twin]. / Einfluss des Geburtsintervalls auf die Sectiorate am zweiten Zwilling nach vaginaler Geburt des führenden Zwillings.

Cesarean section for delivery of the second twin after successful vaginal delivery of the first twin is an infrequent and unusual occurrence. But this management of twin delivery has increased during the last years. A series of 371 pairs of twins born between 1978 and 1991 were reviewed. 12 second twins (3.2%) were delivered by cesarean section after vaginal delivery of the first twin. The initial 20 minutes the main indications were fetal distress and prolapsed umbilical cord. Beyond the first 20 minutes malpresentations were more frequent. In this group we have seen a better fetal outcome. An influence of the interdelivery time on the cesarean section rate of the second twin was not noted. No significant differences were seen for neonatal morbidity for all 197 vaginal delivered second twins with increasing interval.

Neurological adaptation of infants delivered by emergency or elective cesarean section.

The effects of intrapartal asphyxia on neonatal neurological condition have been studied in 17 full-term infants delivered by emergency cesarean section and in 30 full-term infants delivered by elective cesarean section used as controls. A neurological examination consisting of 31 items was performed on days 1, 2 and 5 after birth. A tonus score, an excitability score as well as the number of optimal responses were calculated. A follow-up examination was done at six months of age with a standardized neurological and developmental examination. The results showed that infants born after emergency cesarean section were significantly more hypotone the first two days after delivery than the infants in the elective cesarean section group. In regard to individual neurological items, significant differences were found between the emergency and elective cesarean section in reaction to sound, rooting, patellar, Moro and stepping reflexes with weaker reactions in the elective cesarean section group. Growth, psychomotor development and neurological status at six months did not differ significantly between the groups. Our findings indicate that full-term infants born after emergency cesarean section due to mild intrapartal asphyxia have a delayed neurological adaptation as expressed by poor muscular tonus during their first days of life compared with infants born after elective cesarean section.

[Doppler examination as an indication for surgical delivery. A case report]. / Doppleruntersuchung als Indikation zur operativen Entbindung. Ein Fallbericht.

Pathological alterations in foetoplacental circulation can lead to zero flow or even to reverse flow in the diastole. In these cases, a high fetal risk can be expected. Based on our Doppler measurements, we recommend by zero flow in the umbilical artery or foetal aorta, that the childbirth could be postponed under an observant attitude using intensive controls (CTG, foetal movements), but pregnancy has to be terminated immediately by Caesarean section at the first sign of reverse flow.

[Changes in the lactate dehydrogenase isoenzyme activity in parturients with chronic fetal hypoxia during different types of anesthesia in surgical delivery]. / Izmeneniia aktivnosti izofermentov laktatdegidrogenazy u rozhenits s khronicheskoi gipoksiei ploda pri razlichnykh vidakh anestezii v usloviiakh operativnogo rodorazresheniia.

During cesarean delivery, the isoenzymic spectrum of lactate dehydrogenase and lactic acid levels were examined in 109 parturients with chronic fetal hypoxia. For initial anesthesia, sombrevin, kalipsol, hexenal were applied, basal anesthesia was performed with neuroleptic analgetics and combined electric anesthesia. The findings make it possible to choose the optimal anesthetic agents in this group of parturients in order to make the status of a fetus and a neonate stable and better.

[Delivery of the second twin by cesarean section]. / Sectio beim zweiten Zwilling.

Caesarean operation is a very rare event for delivery of the second twin, after the first one had been delivered by vaginal route. In the following a caesarean section on the second twin will be exhibited after spontaneous delivery of the first one, because a complete extraction was unsuccessful.

[Emergency indications for cesarean section]. / Die Dringlichkeit der Indikation zur Sectio caesarea.

It must be kept in mind that there are few situations that demand immediate surgery. Regarding indications for most caesarean sections, there is enough time for the anaesthesist to administer speedy, but nevertheless orderly premedication and judge the indications for anaesthesia. The anaesthetic technique should be determined in agreement with the obstetrician. In most hospitals, general anaesthesia can probably be performed more quickly than intrathecal or extrathecal anaesthetics. However, this article will not deal with the details involved in these methods.

Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease.

In the state of Connecticut, 233 women with congenital heart defects were prospectively followed up through 482 pregnancies that resulted in 372 infants who were examined frequently during their first 3 years of life. Approximately half of the women had undergone cardiac surgery and they were compared with the women without operation. There was no maternal mortality, and no patient had infective endocarditis, brain abscess or a cerebrovascular accident. The proportion of pregnancies resulting in live births did not differ significantly in mothers with and without cardiac surgery; the average live birth rate was 77 percent in all. However, the number and size of live-born infants was much greater in mothers who had become acyanotic as a result of reparative surgery than in the still cyanotic women, whether or not they had had palliative surgery. In cyanotic women, placental size was abnormally large in relation to birth weight, which was abnormally low. When the mothers were classified according to cardiac function, there was a significant difference between the number of infants born alive to mothers in good to excellent status and the number born to mothers in fair to poor condition. The latter had a significant increase in interrupted pregnancies as well as in cardiovascular complications during pregnancy. The total group had a 16.1 percent incidence rate of infants with congenital heart disease. This rate was corrected to 14.2 percent by removal of seven mothers, two with Noonan's syndrome, one with hypertrophic cardiomyopathy and four with a family history of congenital heart defects.