MISGAV LADACH SURGICAL TECHNIQUE OF CESAREAN SECTION Our experience at Pula General Hospital

Cilj istraživanja. Utvrditi prednosti tehnike carskog reza »Misgav Ladach« u usporedbi s konvencionalnom metodom po Dörffler-u. Ispitanice i metode. U Općoj bolnici u Puli obuhvaćeno je randomiziranim prospektivnim pokusom 104 pacijentica. U 49 pacijentica je izvršen carski rez konvencionalnom metodom, a u 55 izvršena je »Misgav Ladach« operacijska tehnika. Rezultati. U »Misgav Ladach« operacijskoj tehnici u usporedbi s konvencionalnom metodom doka-zali smo da je trajanje ekstrakcije novorođenčeta kraće (p=0,0009), kraće je ukupno trajanje operacijskog zahvata (p=0,0009), smanjena je postoperacijska bol nakon prvog postoperacijskog dana (p=0,021), ranije je ustajanje iz kreveta i hodanje (p=0,013), smanjena je postoperacijska potrošnja analgetika (p=0,0009), vremenski je kraća primjena analgetika (p=0,0009) i raniji je oporavak peristaltike crijeva (p=0,001). Zaključak. »Misgav Ladach« operacijska tehnika u usporedbi s konven-cionalnom metodom značajno skraćuje trajanje operacije, bolji su rezultati s obzirom na postoperacijsku bol, manja je potrošnja analgetika te brža je uspostava osnovnih fizioloških funkcija. Intraoperacijsko krvarenje, morbiditet majke, nalaz na rani, involucija maternice te procjena upalnog odgovora na operacijski pristup nisu se razlikovali u istraženim skupinama pacijentica.Objective. To evaluate the advantages of the »Misgav Ladach« surgical technique compared to the tradi-tional technique of caesarean section. Population and methods. A prospective randomized trial of 111 women undergoing caesarean section was carried out in the Pula General Hospital. 49 operations were performed by the traditional technique of caesarean section, 55 by the »Misgav Ladach« method. Results. It was proved that the cases where the »Misgav Ladach« method was implemented, compared to the traditional method, showed a significantly shorter delivery/extraction and operative time (p=0.0009), the incision pain in the second postoperative day was significantly lower (0.021), we recorded a quicker stand up and walking (p=0.013), significantly less analgesic injections and a shorter duration of analgesia were required (p=0.0009) and the bowel function was sooner recovered (p=0.001). Conclusion. The »Misgav Ladach« method of caesarean section has advantages over the traditional method by being significantly quicker to perform, with diminished postoperative pain and less use of postoperative analgesics. The recovery of physiologic functions is faster. No differences were found in intraoperative bleeding, mother morbidity, scar appearance, uterus postoperative involution and the assessment of the inflammation response to the operative technique

ANTENATAL TESTS AND PREGNANCY OUTCOME IN CASES OF SEVERE INTRAUTERINE GROWTH RESTRICTION THAT WERE PREMATURELY TERMINATED WITH ELECTIVE CAESAREAN SECTION ‒ EXPERIENCES FROM THE PULA GENERAL HOSPITAL

Antenatal tests determining fetal growth are performed in order to recognize intrauterine growth restriction (IUGR) and find early signs of fetal compensatory mechanisms failure. Cardiotocography (non-stress and stress test), doppler measurements of fetal and placentar circulation and the fetal biophysical profile are presently used for this purpose. They should scan fetuses with risk for a bad pregnancy outcome. A severe IUGR can occur due to several reasons, but it is most commonly caused by a deranged placenta function leading to a respiratory insufficiency and fetal hypoxemia. A delayed childbirth in such cases may lead to a deterioration of hypoxia, even of perinatal death. Apart from that, such children often show complications in their neurological development. This retrospective five-year study analyzed the application of antenatal tests and the pregnancy outcome in 18 patients with severe IUGR (fetal weight equal to or below the 5th percentile) who were hospitalized on the Pregnancy pathology ward of the Pula General hospital. In all the cases fetal monitoring was performed using a combination of tests (in most cases doppler measurements and a biophysical profile). The decision on a termination of pregnancy at 35-37 weeks of gestation was reached on the basis of one or more pathological tests (biophysical profile, Doppler or stress test), whereas the pathological test result of the biophysical profile was decisive for pregnancies of less than 35 weeks. The two groups of patients showed no differences in the Apgar score or the pH value of umbilical blood (Apgar 8/8,6- 7,4/8,6 pH 7,29- 7,31). The most newborns from the 35-37 weeks group had normal CNS ultrasound results, as well as normal neuromotoric clinical findings 6 months after birth. The CNS ultrasound performed in the group under 35 weeks detected in most cases an bilateral periventricular echogenicity of the first or second grade, two newborns showed periventricular cystic spaces. All patients from this group had to exercise continuously in order to eliminate the effect of a slower neuromotoric development. Several studies confirmed the biophysical profile to be the best way of guiding pregnancies with intrauterine growth restriction of the fetus. It is the starting point in the procedure of reaching the decision on premature childbirth, especially before the 35th week of gestation. The clinical procedure in our hospital is based on these findings

ANTENATAL TESTS AND PREGNANCY OUTCOME IN CASES OF SEVERE INTRAUTERINE GROWTH RESTRICTION THAT WERE PREMATURELY TERMINATED WITH ELECTIVE CAESAREAN SECTION ‒ EXPERIENCES FROM THE PULA GENERAL HOSPITAL

Antenatal tests determining fetal growth are performed in order to recognize intrauterine growth restriction (IUGR) and find early signs of fetal compensatory mechanisms failure. Cardiotocography (non-stress and stress test), doppler measurements of fetal and placentar circulation and the fetal biophysical profile are presently used for this purpose. They should scan fetuses with risk for a bad pregnancy outcome. A severe IUGR can occur due to several reasons, but it is most commonly caused by a deranged placenta function leading to a respiratory insufficiency and fetal hypoxemia. A delayed childbirth in such cases may lead to a deterioration of hypoxia, even of perinatal death. Apart from that, such children often show complications in their neurological development. This retrospective five-year study analyzed the application of antenatal tests and the pregnancy outcome in 18 patients with severe IUGR (fetal weight equal to or below the 5th percentile) who were hospitalized on the Pregnancy pathology ward of the Pula General hospital. In all the cases fetal monitoring was performed using a combination of tests (in most cases doppler measurements and a biophysical profile). The decision on a termination of pregnancy at 35-37 weeks of gestation was reached on the basis of one or more pathological tests (biophysical profile, Doppler or stress test), whereas the pathological test result of the biophysical profile was decisive for pregnancies of less than 35 weeks. The two groups of patients showed no differences in the Apgar score or the pH value of umbilical blood (Apgar 8/8,6- 7,4/8,6 pH 7,29- 7,31). The most newborns from the 35-37 weeks group had normal CNS ultrasound results, as well as normal neuromotoric clinical findings 6 months after birth. The CNS ultrasound performed in the group under 35 weeks detected in most cases an bilateral periventricular echogenicity of the first or second grade, two newborns showed periventricular cystic spaces. All patients from this group had to exercise continuously in order to eliminate the effect of a slower neuromotoric development. Several studies confirmed the biophysical profile to be the best way of guiding pregnancies with intrauterine growth restriction of the fetus. It is the starting point in the procedure of reaching the decision on premature childbirth, especially before the 35th week of gestation. The clinical procedure in our hospital is based on these findings