48 research outputs found
Patients’ perception of childbirth according to the delivery method: The experience in our clinic
Introduction: The aim of this study is to identify the way in which childbirth in general, and the delivery method in particular, influenced the maternal psychosocial status and the perception upon birth during postpartum. Material and method: We conducted a cohort type 2 prospective study. We included patients who had given birth at “Bucur” Maternity of Hospital “St. John” Bucharest from the 1st of January 2017 until the 1st of January 2018. Results: The majority of the patients (21.05%) who chose to give birth vaginally assigned the maximum degree (10) to the difficulty of birth. The patients who gave birth through cesarean section experienced the feeling of sadness in a higher percentage than those who gave birth vaginally (30.52% versus 21.05%). Among the patients who were in favor of having more children, 85.45% preferred the same delivery method. All the patients who gave birth vaginally wished to have other children using the same method, while 81.4% from the patients who gave birth through cesarean section were in favor of more children. Conclusion: The patients’ perception of childbirth was a subjective parameter. Further studies with standardized questionnaires should be applied for more reliable results
Emergency peripartum hysterectomy, physical and mental consequences: a 6-year study
Emergency peripartum hysterectomy (EPH) is performed for massive postpartum hemorrhage following a cesarean delivery or vaginal delivery, in order to save the patient’s life. The current study was performed on a sample of 13.162 patients, which underwent cesarean or vaginal delivery during a period of 6 years, from 2010 to 2015, in Bucur Maternity Hospital. There were two subsequential groups consisting in: 6593 patients with cesarean operations and 6569 patients with vaginal delivery. In 12 cases occurred one or more of the risk factors that lead to EPH, divided equally across the two groups above.
The main two types of surgery are a more frequent subtotal hysterectomy, which is the preferred type of EPH as it takes less time and is associated with fewer complications, and a total hysterectomy. The majority of procedures were performed at patients over 35 years old (9 of 12), with a median age of 31,16 (ranging from 21 to 44 years old). The most important risk factor present across the lot was multiparity (11 from 12), with cicatricial uterus being the second one (4 of 12).
ICU median time was 4,5 days (ranging from 3 to 15 days), with a median blood transfusion necessity of around 2,4 I.U per patient. There were no mother or newborn reported deaths, neither PTSD following EPH.EPH is a procedure performed as last-resort, life-saving surgery, leaving no time for mental preparation of the patients. This may predispose to negative psychological outcomes, especially because they are not part of decision-making process due to the emergency character of hysterectomy
Patients’ perception of childbirth according to the delivery method: The experience in our clinic
Introduction: The aim of this study is to identify the way in which childbirth in general, and the delivery method in particular, influenced the maternal psychosocial status and the perception upon birth during postpartum. Material and method: We conducted a cohort type 2 prospective study. We included patients who had given birth at “Bucur” Maternity of Hospital “St. John” Bucharest from the 1st of January 2017 until the 1st of January 2018. Results: The majority of the patients (21.05%) who chose to give birth vaginally assigned the maximum degree (10) to the difficulty of birth. The patients who gave birth through cesarean section experienced the feeling of sadness in a higher percentage than those who gave birth vaginally (30.52% versus 21.05%). Among the patients who were in favor of having more children, 85.45% preferred the same delivery method. All the patients who gave birth vaginally wished to have other children using the same method, while 81.4% from the patients who gave birth through cesarean section were in favor of more children. Conclusion: The patients’ perception of childbirth was a subjective parameter. Further studies with standardized questionnaires should be applied for more reliable results
Prenatal Diagnosis of Bovine Aortic Arch Anatomic Variant
Fetal aortic arch development is an early and complex process that depends on many
genetic and environmental factors. The final aortic arch varies greatly; it may take the form of a
normal arch, anatomic variant (AAAV) with a common origin to that of the innominate artery and
left common carotid artery (formerly known as “bovine aortic arch” (with an incidence of up to 27%))
or one of multiple pathological conditions. The present study aimed to establish the feasibility and
impact of prenatal anatomic arch variants’ diagnosis. A retrospective study of 271 fetal second- and
third-trimester anomaly scans was performed in our tertiary center. Examinations that evaluated the
sagittal aortic arch were included and the branching pattern was assessed. Additionally, a literature
data search based on the terms “common origin of innominate artery and left common carotid artery”,
“bovine arch”, “bovine aortic” and “aortic arch anomalies” was performed. Results that referred to
prenatal AAAV were retained and the papers evaluated. In our study, the AAA incidence was 1.93%,
with 4 out of 5 cases being arch type B. All cases had minor associated conditions but a good postnatal
outcome. An anatomic aortic variant with a common IA and LCCa prenatal diagnosis was found
in a small number of studies; most of the cases described in pediatric and adult series were related
to cardiac surgery for stenting, aneurysm or thoracic-associated diseases. The incidence of AAAV
varied from 6 to 27% depending on the population studied (highest incidence in African individuals).
The variant was highly associated with aortic dissection, pulmonary and cerebral embolism and
increased risks of incidents during surgery. Diagnosing AAAV during a routine anatomic scan is
feasible and diagnoses can be made when anomaly scans are performed. Awareness of the condition
is important for postnatal surgery when other cardiac anomalies are found; this can prevent accidents
with simple changes to the patient’s lifestyle, and, in the case of surgery, means we can adopt the
correct surgical approach
Persistent Left Superior Vena Cava Significance in Prenatal Diagnosis : Case Series
The persistent left superior vena cava (PLSVC) is a congenital heart anomaly reported in
0.3–0.5% of the general population and can be associated with congenital heart diseases in up to 8% of
cases. Prenatal identification of PLSVC is important to prompt an extended cardiac and extracardiac
fetal examination. We retrospectively reevaluated anomaly scans performed in our unit in a 2-year
interval according to the national guidelines to evaluate the incidence of PLSVC and its association
with prenatal morbidity. In our population, the incidence of PLSVC was 0.31%, and we found a low
association with cardiac and extracardiac anomalies. The standard sections (three-vessel and trachea
view, four-chamber view and outflow tract’s view) are insufficient to exclude cardiac anomalies
whenever PLSVC is found. In our case series, only one newborn required postnatal surgery for total
pulmonary vein anomaly, and at 2 years of life all babies had a normal evolution. Prenatal diagnosis
of PLSVC can raise counseling issues; therefore, awareness of its good outcome when isolated and
need for an extended examination to rule out other anomalies is very important
The quality of sexual life after vaginal surgical interventions
Introduction. The malfunction of the supporting pelvic system generates signs and symptoms that require various procedures. The aim of our study was to evaluate whether vaginal surgical interventions for genital prolapse or urinary incontinence have an impact on patients’ sexual quality of life. Materials and methods. We studied 40 eligible women who underwent vaginal surgical procedures in Saint John Hospital, Bucharest. Patients completed a questionnaire 6 months after the intervention. Results. Patients who underwent vaginal surgery for prolapse were 50-64 years of age. The most frequent vaginal surgical intervention was vaginal hysterectomy (32.5%), followed by anterior and posterior colporaphy (17.5%), and direct cystopexy (15.0%). Regarding their sexual life, 42.5% patients described improvement in sexual life, 22.5% described decreased libido after surgery, and 35% indicated no significant improvement. 57.5% of women indicated that they had no sexual discomfort (57.5%), whereas 27.5% had dyspareunia and 15% had dysuria. There was no negative impact on patients’ male partner quality of sexual intercourse after intervention. Conclusions. Vaginal surgical interventions for genital prolapse or urinary incontinence do not appear to lead to significant alteration of quality of sexual life in women
The Accuracy of Cytology, Colposcopy and Pathology in Evaluating Precancerous Cervical Lesions
Cervical cancer (CC) is the third most common cancer in the world, and
Romania has the highest incidence of cervical cancer in Europe. The aim of this study was to
evaluate the correlation between cytology, colposcopy, and pathology for the early detection of
premalignant cervical lesions in a group of Romanian patients. Methods: This observational type 2
cohort study included 128 women from our unit, “Bucur” Maternity, who were referred for cervical
cancer screening. Age, clinical diagnosis, cytology results, colposcopy impression, and biopsy results
were considered. Colposcopy was performed by two experienced examiners. The pathological
examination was performed by an experienced pathologist. Results: The cytology found high-grade
squamous intraepithelial lesions in 60.9% of patients, low-grade squamous intraepithelial lesions
in 28.1%, atypical squamous cells for which a high-grade lesion could not be excluded in 9.4%,
and atypical squamous cells of undetermined significance, known as repeated LSIL, in 1.6%. The
first evaluator identified low-grade lesions in 56.3%, high-grade lesions in 40.6%, and invasion in
3.1% of patients. The second evaluator identified low-grade lesions in 59.4%, high-grade lesions in
32.0%, and invasion in 8.6% of patients. The pathological exam identified low-grade lesions in 64.1%,
high-grade lesions in 25%, and carcinoma in 14% of patients. The colposcopic accuracy was greater
than the cytologic accuracy. Conclusions: Colposcopy remains an essential tool for the identification
of cervical premalignant cancer cells. Standardization of the protocol provided an insignificant
interobserver variability and can serve as support for further postgraduate teaching
Foetal Intrapartum Compromise at Term : Could COVID-19 Infection Be Involved? A Case Report
The impact of the SARS-CoV-2 infection on pregnancy has been studied and many reports
have been published, mainly focussing on complications and in utero transmission with neonatal
consequences. Although the effects of other viruses on foetuses are well known, the impact of
maternal COVID-19 during pregnancy is not completely understood. We report a case of acute foetal
intrapartum hypoxia without other risk factors than maternal COVID-19 disease 2 weeks previous
to birth at term. Placental histological changes suggested that the viral infection could have been
the culprit for the unfavourable outcome during labour. The neonate was promptly delivered by
Caesarean section. Neonatal intensive care was started, including therapeutic hypothermia. The
procedure was successful, the evolution of the neonate was favourable, and she was discharged after
10 days. Follow-up at 2 months of life indicated a normal neurological development but a drop in
head growth. The case raises the idea that pregnancies with even mild COVID-19 symptoms may
represent the cause of neonate compromise in a low-risk pregnancy. An important follow-up in the
neonatal period and infancy is required to identify and treat any subsequent conditions. Further
long-term studies are necessary to identify a cause–effect relationship between COVID-19 pregnancies
and the whole spectrum of neonatal and infant consequences
Abdominal-pelvic pain in female patients with endometriosis - a review of the literature
Abdominal-pelvic pain is the dominant symptom in endometriosis, one of the most common pathologies that affect women, being also a multifactorial disorder. Exploratory laparoscopy allows the correct assessment of the location as well as severity and extent of the lesions, thus representing the current gold standard in diagnosis. The correlation of pain intensity with the evolutionary stage of endometriosis is inconstant. Surgical treatment, preferably performed laparoscopically, includes the excision of the ectopic endometrium, having as a primary objective the control of persistent pain and the removal of all endometriotic foci. This procedure helps to improve the life quality of the patient, to reduce relapses, to control postoperative pain, and to eliminate the disease. Pre- and post-operative adjuvant medical treatment is used due to its effects on the symptomatology, prolonging the asymptomatic period of the disease. Despite the use of the above procedures, there are cases in which the abdominal-pelvic pain persists even after surgery, which makes endometriosis a significant challenge for both the specialist and the patient, as well as for the medical system itself, as the study of the pathogenic mechanisms is yet the subject of numerous studies. Nutritional education in these patients is essential, given the recommendation to restrict the range of foods and to increase other foods that have an important role in reducing the risk or even leading to regression of the endometrial pathology
Conduita terapeutica in hemoragia din postpartum
UMF „Carol Davila”, Clinica „Bucur”, Spitalul Clinic „Sf. Ioan”, Maternitatea”Bucur”, Bucureşti, România,
Al VI-lea Congres Național de Obstetrică și Ginecologie cu participare internațională, 13-15 septembrie 2018, Chișinău, Republica MoldovaIntroducere: Hemoragia din postpartum reprezintă o cauza importanta de morbididate şi mortalitate materna. Cauzele cele mai frecvente sunt: atonia uterina, soluţiile de continuitate, aderenţele anormale ale placentei şi coagulopatie.
Material şi metode: Am revizuit baze de date medicale internaţionale cu studii randomizate, meta-analize referitoare la tendinţele actuale despre histerectomia postpartum si tehnicile alternative in hemoragia din postpartum.
Rezultate: Incidenţa hemoragiei din postpartum este de 1% in condiţiile unei atitudini terapeutice rapide. Tratamentul este direcţionat de cauză. Astfel, pentru atonie uterină iniţial se tentează mijloace farmacologice şi ulterior gesturi chirurgicale precum ligatura arterei uterine - O’Leary sau ligatura arterei hipogastrice. Sutura B-Lynch si variantele
acesteia sunt concepute pentru realiza compresia uterului prin forţă mecanică. Baloanele uterine sunt proiectate pentru a realiza tamponarea zonele de sângerare placentară. Aceasta este cea mai efi cientă metoda deoarece cateterul aplică presiune directă la locul de sângerare. Dispozitivele cu balon uterin concepute special pentru tamponadă uterină
după naştere vaginală sau cezariană includ: cateterul Foley, Balon Bakri, dispozitiv B-T Cath şi dispozitiv dublu-balon Ebb care este, de asemenea, proiectat şi pentru hemostaza cervicală. Radiologia intervenţională impune gestionarea avansată, minim invazivă a hemoragiei în postpartum.
Conclusii: Utilizarea uterotonicelor, ligaturile vasculare pelvine şi tamponadele cu baloane sunt primii paşi în abordarea terapeutică a hemoragiei din postpartum. Conduita adecvată constă într-o atitudine promtă, deseori cu echipă multidisciplinară