Recurrent incarceration of the retroverted gravid uterus at term - two times transvaginal caesarean section:a case report

INTRODUCTION: Persistent retroversion of a gravid uterus (incarceration) in the third trimester is an extremely rare diagnosis and is only scarcely been described. Its prevalence may lead to increased foetal mortality and maternal morbidity. CASE PRESENTATION: We present a case where a 35-year-old patient had undiagnosed (recurrent) uterine incarceration at term. Operative delivery proved difficult due to distorted anatomy. Therefore, in our case delivery of the fetus through transvaginal caesarean section was required. CONCLUSION: This case report discusses the diagnosis and management of (recurrent) incarceration of the retroverted uterus at term resulting in two successful transvaginal caesarean sections. In presenting this case, we aim at improving awareness, diagnosis and treatment of the retroverted incarcerated gravid uterus

Recurrent incarceration of the retroverted gravid uterus at term - two times transvaginal caesarean section:a case report

INTRODUCTION: Persistent retroversion of a gravid uterus (incarceration) in the third trimester is an extremely rare diagnosis and is only scarcely been described. Its prevalence may lead to increased foetal mortality and maternal morbidity. CASE PRESENTATION: We present a case where a 35-year-old patient had undiagnosed (recurrent) uterine incarceration at term. Operative delivery proved difficult due to distorted anatomy. Therefore, in our case delivery of the fetus through transvaginal caesarean section was required. CONCLUSION: This case report discusses the diagnosis and management of (recurrent) incarceration of the retroverted uterus at term resulting in two successful transvaginal caesarean sections. In presenting this case, we aim at improving awareness, diagnosis and treatment of the retroverted incarcerated gravid uteru

Cost-minimization analysis of domiciliary antenatal fetal monitoring in high-risk pregnancies

OBJECTIVE: To compare safety and cost-effectiveness of domiciliary antenatal fetal monitoring (cardiotocography and obstetric surveillance) with in-hospital monitoring in high-risk pregnancies. METHODS: From September 1992 to June 1994, 150 consecutive women with high-risk pregnancies, who would otherwise be monitored in the hospital, entered a randomized controlled trial of in-hospital (n = 74) or domiciliary (n = 76) monitoring. The main outcome measures were neonatal safety (Prechtl neurologic optimality score, the proportion of non-optimals) and cost-effectiveness. To test a two-point difference in mean Prechtl scores (two-tailed o = .05. 1-beta = .80), 150 women were needed. Safety and cost-effectiveness were analyzed according to intention to treat. Conditional on the safety outcomes, a cost-minimization analysis based on actual resource use was performed. Uncertainty of results was explored by sensitivity analyses. RESULTS: Neonatal outcomes were equal. No cost-shifting between the antenatal and postpartum period occurred. Substituting domiciliary for in-hospital monitoring reduced mean (standard deviation) antenatal costs from $3558 ($2841) to $1521 ($1459) per woman (P < .001). If costs were varied by the addition of 50%, costs were still reduced. The magnitude of the reduction was sensitive to the costs of hospital care and less sensitive to the costs of domiciliary monitoring. CONCLUSION: Domiciliary monitoring is safe and reduces costs by one-half. The technique seems transferable to other settings but local circumstances may sometimes hamper its disseminatio