Pregnant surgeon — assessment of potential harm to the woman and her unborn child

Although most countries developed regulations concerning pregnant women at work, they are not strictly adjusted for every profession. In the European countries directives prevent pregnant women from working during night shifts, but apart from a vague paragraph about avoiding hazardous agents, there are no guidelines specific for pregnant surgeons. The aim of the study was to analyse the risks and consequences of working in the operating theatre during pregnancy. An in-depth analysis of available literature, laws and regulations concerning health and safety of pregnant surgeons was performed. Not only they are surgeons exposed to radiation and infectious agents like any other physicians, but they also face the risk of strenuous physical activity affecting their pregnancy. The unpredictability of this occupation, prolonged hours and stress associated with work can all affect the future mother and her child. The available research on potential risks for pregnant women performing surgical activities named such consequences as premature birth, miscarriage, foetal growth retardation, hypertensive disorders and infertility. There are no unanimous guidelines for pregnant surgeons on how long and to which extent they should work. The key is to maintain a balance between limiting the likelihood of pregnancy complications and respecting women’s voluntary wish to continue professional development

Eradication of cervical canal colonization associated with prophylactic cervical cerclage: the look further study

Objectives: The perioperative management of the cervical cerclage procedure is not unified. In general population controlling microbiome cervical status does not affect obstetric outcomes, but it might be beneficial in patients with cervical insufficiency. The aim of our study was to present the obstetric, neonatal and pediatric outcomes of patients undergoing the cervical cerclage placement procedure in our obstetric department using a regimen of care that includes control of the microbiological status of the cervix and elimination of the pathogens detected. Material and methods: Thirty-five patients undergoing cervical cerclage in the 2nd Department of Obstetrics and Gynecology, Medical University of Warsaw, were included in the study. The procedure was performed only after receiving a negative culture from the cervical canal. Results: Thirty-one (88.6%) patients delivered after the 34th and twenty-eight (80.0%) after the 37th week of gestation. The colonization of the genital tract was present in 31% of patients prior to the procedure, in 42% of patients — during the subsequent pregnancy course and in 48% of patients — before delivery. A total of 85% of patients who had miscarriage or delivered prematurely had abnormal cervical cultures. In patients with normal cervical cultures, and 91.7% of women delivered at term. No abnormalities in children’s development were found. Conclusions: Controlling microbiological status of the cervical canal results in better or similar outcomes to those reported by other authors in terms of obstetric and neonatal outcomes. Active eradication of the reproductive tract colonization potentially increases the effectiveness of the cervical cerclage placement

Risk factors for unsuccessful vaginal birth after caesarean at full dilatation

Objectives: The purpose of this study was to determine the risk factors for caesarean sections in the second stage of labour after a previous caesarean section among women who underwent trial of labour (TOL). Material and methods: From a total of 639 women who experienced one caesarean section, 456 women were qualified for TOL. From this group, 105 women were subjected to a caesarean section in the first stage of labour and another 351 women reached the second stage of labour. From the latter group, 309 women delivered naturally and 42 were subjected to a caesarean section. Results: Risk factors for the necessity of performing a caesarean section in the second stage of labour after a previous caesarean section was the weight gain during pregnancy (OR = 1.07), the height of fundus uteri (OR = 1.25) before delivery, and the estimated foetal weight (OR = 1.01), a past delivery of a child with a birth weight exceeding 4.000 g (OR = 2.14), the presence of pre-gestational diabetes (OR = 15.4) and gestational diabetes (OR = 2.22), necessity of applying a delivery induction (OR = 2.52), stimulation of uterine activity during delivery (OR = 2.43) and application of epidural analgesia (OR = 4.04). A factor reducing the risk of a caesarean section in the second stage was a vaginal delivery in a woman’s history (OR = 0.21). Conclusions: Women should be encouraged to deliver naturally after a previous caesarean section, especially when their history includes a vaginal delivery and if there is no need for labour induction