Early diagnosis of uterine rupture after previous cesarean section]

A new diagnostic measure for the early detection of still uterus rupture before birth and previous cesarian section is reported. With a portio ready for birth, which permits the finger to pass readily, the possibility exists, after stripping of the membranes, to examine digitally the old caesarian scar in respect of a beginning or already existing scar dehiscence. In 112 investigated patients with this method, once a beginning, six times an incomplete and once a complete uterus rupture prior to another partus was seen. In six cases a stenosis was found in the old section region with retention of the foetal head and threatening uterus rupture.     

Vaginal birth after cesarean section in the grand multipara with a previous lower segment scar

Raised levels of agalactosyl immunoglobulin G (IgG) have been found in adults with tuberculosis, Crohn's disease and rheumatoid arthritis, and recent evidence, both circumstantial and experimental, suggests that it has distinct functional properties that play a role in pathogenesis. Since tuberculosis in infants is strikingly different from the disease seen in adults, but switches to the adult form at adrenarche or puberty, we documented the association of agalactosyl IgG with tuberculosis in childhood between the ages of 0 and 16 years. Sera were collected from 99 children diagnosed as cases of tuberculosis in Istanbul, Turkey, and compared with levels in non-tuberculous controls. The percentage of agalactosyl IgG was significantly raised in children with tuberculosis overall (P < 0.001, Mann-Whitney U test) and in all age groups except for children over 12 years old, whose numbers were too small to be meaningful. Therefore the differences between adult and childhood tuberculosis are not due to a difference in the tendency for agalactosyl IgG to be produced at different ages. The percentage of agalactosyl IgG may be useful for monitoring the progress of individual complicated cases.     

Pattern of cervical dilatation in previous lower segment caesarean section patients

The pattern of cervical dilatation during labour in 100 patients with previous lower segment caesarean section (LSCS) was determined in a prospective partographic study. Eighty-four subjects delivered successfully by vaginal route. The mean initial dilatation rate (IDR) and average dilatation rate (ADR) were 0.884 cm/hour and 1.255 cm/hour respectively. The mean IDR and ADR of the patients who delivered vaginally were 0.96 cm/hour and 1.41 cm/hour respectively, while of those who required repeat LSCS mean IDR was 0.44 cm/hour and mean ADR was 0.42 cm/hour. Hence ADR in cases who required repeat LSCS was significantly slower as compared to those who delivered vaginally (p < 0.01). Most (87.5%) of the cases who required repeat LSCS crossed the alert line as compared to 34.5% of patients who delivered vaginally. The mean admission delivery interval (ADI) was 9.45 +/- 4.29 hours in patients with no previous vaginal delivery and 8.02 +/- 4.83 hours in patients with previous vaginal delivery. The mean durations of 1st and 2nd stages of labour were 11.8 +/- 5.35 hours and 29.4 +/- 27.3 minutes respectively. It is concluded that partographic evaluation is an important aspect in management of labour of such patients.     

Randomized study of non-closure of peritoneum in lower segment cesarean section

PURPOSE: 31P CP/MAS NMR is used to characterize stability and changes in solid state properties of disodium clodronate tetrahydrate upon variable temperature and slow dehydration. METHODS: Variable temperature 31P CP/MAS NMR spectroscopy. RESULTS: A fast rise in temperature leads to loss of lattice waters and produces an averaged structure characterized by a single 31P NMR resonance at 398 K. Slow room temperature dehydration converts the crystalline form to an anhydrous structure with two non-equivalent phosphorus atoms. The molecular skeleton of clodronate is stable within the temperature range 296 K-398 K of experiments. Rehydration of the anhydrous samples at room temperature restores the crystalline tetrahydrate form verified by a 31P CP/MAS NMR spectrum similar to that of a virginal sample. CONCLUSIONS: Solid state NMR is a method which can offer both molecular and crystal scale information, when either bulk or dosage forms of a drug can be altered by temperature or by loss of lattice waters or solvents. The experiments are easy to perform, though time consuming, especially when low abundant nuclei are examined.     

Prevention with antibiotics in cesarean section

The investigation of 222 patients with caesarean section showed an increasing bacterial invasion of the amniotic fluid, when in the patients preoperative was found: - clear or green colored (meconic) amniotic fluid and intact membranes, - clear amniotic fluid with ruptured membranes and - green-colored (meconic) amniotic fluid and ruptured membranes. In support to some conceptions from the literature a perioperative prophylaxis with antibiotics is recommended in the groups, which are potentially endangered postoperatively.     

Fertility in anovulatory patients after primary cesarean section

We report a successful surgical treatment of an infective thoracic aortic aneurysm ruptured to the left lung. A 63-year-old man who had been suffering from fever and cough showed twice of hemoptysis. Chest CT revealed a descending thoracic aortic aneurysm ruptured to the left lung. A semiemergent operation was performed. At operation, aneurysm of descending thoracic aorta was found adherent to the left lung. Aneurysmectomy with left pneumonectomy was carried out. The postoperative course of the patient was uneventful. Conceivably, in order to avoid massive intraoperative bleeding during division of dense adhesion and postoperative graft infection, concomitant lung resection is necessary.     

Complications for the mother in vaginal delivery after a prior cesarean section and in parturients with a planned repeat cesarean section

Over a period of 10 years (1980-1989) in the Clinic of Obstetrics and Gynaecology in Stara Zagora 740 women have delivered children after a previous caesarean operation. On the basis of this material the author has studied the vaginal delivery complications for the mother after a previous caesarean operation and in the cases of a second planned caesarean operation. The alternative and correlational analysis of the clinical data has shown that the complications for the mother in the latter group are 3 times more than those in the former group.     

Intrathecal opioids provide satisfactory conditions in labor analgesia and spinal anesthesia for cesarean section

Metastases is an uncommon cause of tumors in the sinonasal region. We report a patient with hepatocellular carcinoma which metastasized to the nasal cavity.     

Indications for cesarean section in singleton pregnancies in two Danish counties with different cesarean section rates

After observing spikes in the Doppler signal of cerebral arteries of patients with neurologic symptoms and prosthetic heart valves, we then studied two groups of patients with prosthetic heart valves: seven patients with neurologic symptoms and 65 asymptomatic patients. Using transcranial Doppler sonography of the middle cerebral artery, we found Doppler spikes in six symptomatic and 24 asymptomatic patients with mechanical heart valves. No spikes were found in one symptomatic and 21 asymptomatic patients with biological valves or in 20 asymptomatic patients with mechanical valves. We concluded that gas cavitation during the opening or closure of the valve, producing bubble emboli, is the most probable explanation for these Doppler spikes in patients with mechanical prosthetic heart valves.     

Althesin in cesarean section

The indications for the employment of Althesin in caesarean section are explained and a substantially favourable opinion is expressed on its clinical effects. Absence of neonatal depression is attributed both to the distribution and metabolism of the drug, and to the features of foetal circulation at term.     

Late post-partum hemorrhage after cesarean section due to rupture of a false aneurysm of the uterine pedicle

We report a 14 year-old girl with a huge adenomatous goiter in the left lobe in the thyroid gland reaching the aortic arch with elevated thyroglobulin. The tumor grew rapidly for two years since the initial diagnosis as an euthyroid hemilateral goiter. Ultrasonography revealed multinodular tumors and magnetic resonance imaging made clear the lower expanding site of the tumor. We recommend careful follow up of hemilateral diffuse goiters by ultrasonography for earlier detection of nodular changes as seen in our case.     

Modernizing curvilinear continuous-casting machines with a vertical section

Various designs of continuous-casting machines installed at OAO MMK are considered. Steel casting is analyzed as a function of the casting-machine design.     

Antibiotic prophylaxis in cesarean section

BACKGROUND: To investigate the guidelines for patient selection and drug regimens for application of antibiotic prophylaxis in relation to cesarean section in the maternity clinics in Denmark. METHODS: A questionnaire to all the Danish maternity clinics that perform cesarean section, concerning indications for application of antibiotic prophylaxis and antibiotic regimens to patients undergoing acute and elective cesarean section. RESULTS: All departments (n = 48) returned the questionnaire. Twenty departments (46%) provided written guidelines for antibiotic prophylaxis. Four departments (8%) used antibiotic prophylaxis to elective cesarean sections, 25 departments (52%) applied antibiotics to all emergency sections. In the presence of the rupture of membranes or prolongation of labor (> 12 hrs) 58% and 63% of the departments applied antibiotic prophylaxis, respectively. The most infrequent first choice drug was cefuroxim, employed by 27 departments (56%). Concerning timing, 21 departments (44%) applied antibiotics after cord clamping and 13 departments (27%) before incision. CONCLUSION: We propose a nation-wide prospective investigation on the rate of infections associated with cesarean section to set up rational guidelines for antibiotic prophylaxis.     

The anesthetic management of cesarean section for multiple pregnant patients

Anesthetic management of cesarean section for twenty multiple pregnant patients, who were pregnant with triplet or quadruplet, was compared with that for 325 single pregnant patients and 21 twin pregnant patients. For anesthetic methods, spinal anesthesia was chosen most frequently in the multiple pregnant patients, as in single and twin (more than 75 percent). In multiple pregnant patients, the incidence of emergency operation was less. In multiple pregnant patients who received spinal anesthesia, gestational age was lower; birth weight was lighter; length of fundus uteri was longer; and blood loss including amniotic fluid was larger. In triplets, the third infants' UID-time was prolonged and their Apgar score was lower.     

The first cesarean section in Norway

The first reported caesarean section in Norway was performed on 20 August 1843 by a general practitioner, Lars Thalian Backer (1812-84). The operation took place in Lardal, Vestfold County, on a 27 year old woman who had been in labour for six days. The outcome was disastrous; she was delivered of stillborn twins and died 2 1/2 days after the operation. In the 19th century, infection, bleeding and thromboembolic disease made caesarean section a dangerous operation, and only 26 such operations are known in Norway, most of them performed outside hospitals. The first caesarean section in Norway resulting in a living child was performed in 1849, but no mother survived the operation before 1890. We recapitulate the caesarean section of 1843; Dr Backer and his qualifications for operative obstetrics; and the state of instrumental and surgical obstetrics in Norway at that time.