23 research outputs found
Effect of endometrial polyps, histology, intrauterine localization and the technique of polypectomy On Fertility
KAL
A magzati aorta descendens és artéria cerebri media rezisztencia index hånyadosånak értékei az élettani terhesség harmadik trimeszterében
L
Large fetal weight alone in Robson-1 parturients doesn't translate into a risk of Caesarean delivery higher then that of a vaginal birth
L
SzĂŒlĂ©s mĂłdja Ă©s neonatĂĄlis eredmĂ©nyek: terminuson tĂșl szingulĂĄris fejvĂ©gƱ magzattal spontĂĄn vajĂșdĂł, elĆször szĂŒlĆ nĆk körĂ©ben
L
Effect of High Body Mass Index, Increased Weight Gain and Single- Versus-Double Layer Uterine Incision Closure on Success of Vaginal Birth After Cesarean Delivery
A csĂĄszĂĄrmetszĂ©s napjaink leggyakrabban elvĂ©gzett hasi mƱtĂ©tes beavatkozĂĄsa. A magzati diagnosztika fejlĆdĂ©se, az ultrahang szĂ©leskörƱ alkalmazĂĄsa, a szĂŒlĂ©s alatti magzati Ă©szlelĂ©s fejlĆdĂ©se Ă©s a szĂŒlĂ©szeti szakmĂĄra nehezedĆ jogi nyomĂĄs a 30 Ă©vvel ezelĆtt jellemzĆ 5%-os CS frekvenciĂĄt a XXI. szĂĄzad elejĂ©re vilĂĄgszerte 30%-ra emelte. Az elmĂșlt 3 Ă©vtizedben sok prĂłbĂĄlkozĂĄs törtĂ©nt nemzeti Ă©s nemzetközi szinten egyarĂĄnt az emelkedĆ tendencia megĂĄllĂtĂĄsĂĄra. A VBAC ezen a tĂ©ren egyike a legjobban alkalmazhatĂł mĂłdszereknek, megfelelĆ terhes populĂĄciĂłnĂĄl alkalmazva sikeressĂ©gi arĂĄnya randomizĂĄlt tanulmĂĄnyok eredmĂ©nyei alapjĂĄn 60-80% között mozog. Sajnos az utĂłbbi nĂ©hĂĄny Ă©vben a mĂ©hrepedĂ©sek kapcsĂĄn közölt adatok miatt a mĂłdszer nĂ©pszerƱsĂ©ge vilĂĄgszerte csökkent.
TovĂĄbb nehezĂti az egĂ©szsĂ©gĂŒgyi ellĂĄtĂĄst vĂ©gzĆ szakemberek helyzetĂ©t, hogy robbanĂĄsszerƱen nĆtt az elmĂșlt Ă©vtizedben a tĂșlsĂșlyos emberek szĂĄma. Ma minden 6. ember a Földön tĂșlsĂșlyos vagy kövĂ©r, ami Ă©rtelemszerƱen emeli azoknak a nĆknek a szĂĄmĂĄt is, akik mĂĄr eleve sĂșlyfelesleggel indulva terveznek terhessĂ©get. Ezek a vĂĄrandĂłs kismamĂĄk sokkal fogĂ©konyabbak terhessĂ©gi cukorbetegsĂ©gre Ă©s a tĂșlsĂșllyal összefĂŒggĆ Ă¶sszes kockĂĄzatra, mint a terhessĂ©g indukĂĄlta hypertonia, a preeclampsia, macrosomia, szĂŒlĂ©s alatti komplikĂĄciĂłk Ă©s az esetleges mƱtĂ©ti Ă©s aneszteziolĂłgiai kockĂĄzat. Ebben a populĂĄciĂłban eleve nĆ a CS elĆfordulĂĄsi gyakorisĂĄga Ă©s csökken a VBAC sikeressĂ©ge.
TanulmĂĄnyomban arra mutattam rĂĄ, hogy bĂĄr a magas testtömeg index Ă©s a terhessĂ©g alatti tĂșlzott sĂșlygyarapodĂĄs a terhessĂ©get megelĆzĆ BMI Ă©rtĂ©kek növekedĂ©sĂ©vel pĂĄrhuzamosan egyĂ©rtelmƱen csökkenti az elĆzmĂ©nyi CS-en ĂĄtesett nĆknĂ©l a VBAC gyakorisĂĄgĂĄt, a mĂłdszer sikeressĂ©gi arĂĄnya mĂ©g a legmagasabb BMI-vel rendelkezĆ kohortban is 65% fölötti volt. Nem szabad Ă©s nem is tehĂĄt kell eleve eldönteni egy elĆzmĂ©nyi CS-en ĂĄtesett, tĂșlsĂșlyos kismama sorsĂĄt jelen terhessĂ©ge kimenetele szempontjĂĄbĂłl. MegfelelĆ pĂĄciens szelekciĂłval, teljes körƱ informĂĄciĂł nyĂșjtĂĄssal Ă©s a szĂŒlĂ©s megfelelĆ irĂĄnyĂtĂĄsĂĄval a VBAC tovĂĄbbra is sikeresen alkalmazhatĂł ezeknĂ©l a vĂĄrandĂłsoknĂĄl, hozzĂĄjĂĄrulva ahhoz, hogy a CS frekvencia legalĂĄbb a jelenlegi szinten stabilizĂĄlĂłdjon vilĂĄgszerte.
-----
Cesarean section is one of the most frequently performed abdominal operations nowadays. As techniques such low transverse scar, that increased the safety of cesarean delivery were used more often, new features of fetal monitoring and ultrasound diagnostics were introduced and medico-legal pressures on physicians increased, indication for cesarean birth were liberalized. After declining for many years in the 1990s the cesarean rate peaked at 30,3% in 2005, the highest percentage ever reported in the USA. In the past three decades a lot of efforts have been made both on national and international levels in order to stop this tendency. VBAC is an ideal and safe method in decreasing high cesarean section rates, but unfortunately the popularity of this method has been drastically dropped down due to the reason of publications on uterine ruptures.
Excessive weight gain and obesity have an increasing relevance in obstetrics. As the modernized nationsâ fastest growing epidemic obesity is having devastating effects on multiple fronts: it exacerbates existing illnesses, increases the risk of developing others, and poses a severe health threat for generations to come. Overweight and obesity have long been known to complicate pregnancy and are associated with increased risk for pregnancy-induced hypertension, preeclampsia and gestational diabetes, as well as anesthesia-related risks, should the woman undergo surgery. Among these women the incidence of cesarean delivery increases while VBAC success decreases.
In my study I emphasized that obese patients and those who gain more than 40 lb during the pregnancy are less likely to have VBAC success. I have demonstrated that an inversely proportional relationship exists between VBAC success rates and prepregnancy BMI. We also found that a history of a previous VBAC makes a patient 7 times more likely to repeat that success in a future attempt. The data clearly shows that women who have had a previous successful VBAC, those who had a previous cesarean delivery for a nonrecurring indication, and those whose fetuses weighed less than 4,000 grams at delivery are more likely to have successful VBAC attempts. I also showed that uterine rupture is much likely to happen in patients whose wound was closed in a single-layer fashion during the previous operation.
Given the known risks associated with attempting VBAC, patient selection to optimize VBAC success and minimize complications becomes of paramount importance. Although obese candidates may succeed, they do so with longer labors, increased complication rates, and a baseline increased risk for cesarean. Obesity is not a contraindication for VBAC, but obese patients need appropriate counseling to understand the risks of attempting a vaginal trial after previous cesarean.Ph
SĂșlyos cervikĂĄlis diszplĂĄzia kimetszĂ©ses mƱtĂ©ti kezelĂ©se 2000-ben MagyarorszĂĄgon Ă©s a debreceni NĆi KlinikĂĄn
L
TeljesĂtmĂ©ny, bevĂ©tel Ă©s rĂĄfordĂtĂĄs a szĂŒlĂ©szeti-nĆgyĂłgyĂĄszati fekvĆbeteg-ellĂĄtĂĄsban: debreceni tapasztalatok
L