scholarly journals Forgotten obstetric procedures

2014 ◽  
Vol 8 (4) ◽  
pp. 42-44
Author(s):  
Janusz Kubicki

In the Medieval Times every third woman died during labour. The labour was assessed by uneducated women called ‘wise crones’, therefore, the procedure was called ‘croning’. It was not until Renaissance, when men were accepted as obstetricians. Then, the medics who were familiar with the anatomy joined to the profession along with well-educated surgeons who introduced a number of obstetric procedures, most of which have already been forgotten for a long time. There were two key moments in the development of modern obstetrics, namely, the introduction of forceps delivery by Chamberlane and Palfyn and the execution of the Caesarean section (C-section). In the case of breech presentation, the use of breech hooks and Wincle-Martin-Wiganda procedure were completely withdrawn along with external rotations. Only twofnger rotation, in the case of premature labour and incomplete cervical dilatation, is still used. Internal rotations, in the cases of complete dilatation, are performed only during the delivery of the second baby in twin pregnancy when the second foetus remains in horizontal position, after the delivery of the frst twin. One of the most signifcant moments in obstetric history was also the procedure performed by a midwife Justyna Siegemundin who turned the foetus in the uterus holding its foot with the use of a special obstetric tape. The procedures of craniotomy (reducing the foetal head size), cleidotomy (reducing the foetal shoulder girdle size by cutting the collarbone), exenteratio (reducing the foetal trunk size) or decapitation (cutting of the foetal head) are never used any longer. The procedures of symphysiotomy (cutting the symphysis) or Schuhardt’s extensive uterine muscle incision have also been suspended. Last but not least obstetric procedure, which is not used contemporarily, is the Fritsch’s grip used to stop atonic postpartum haemorrhage. Keyword: history, caesarean section, forceps, rotations/versio

Author(s):  
Omar Gassama ◽  
Magatte Mbaye ◽  
Aminata Niass ◽  
Diodio Boye ◽  
Babacar Biaye ◽  
...  

Background: Twin pregnancy is the simultaneous development of two embryos and then two fetuses in the uterine cavity. Objective of present study was to assess the epidemiological, clinical, prognostic and therapeutic aspects of twin delivery in two referral maternity units in Dakar.Methods: A descriptive and analytical retrospective bi-centric study of all cases of twin deliveries recorded in two referral center in Dakar was conducted during the period January 1st, 2005-December 31st, 2015, i.e. an 11-year period. It concerned 619 pregnant women who gave birth to twins in these two referral medical structures. The epidemiological parameters, clinical, prognostic and therapeutic aspects of twin childbirth were studied. The data were entered and analysed using Epi info version 3.5.3.Results: The twinning prevalence was 1.11%. The majority of our parturient women (506 or 81.7% of the cases) came from the Dakar suburbs. The average age of the parturient women was 28 years and the gestity age 3.1. Pregnancy was well monitored for 98.5% of the parturient women with an average number of prenatal consultations of 3.6. The first prenatal consultation was performed in 52% of cases in the first quarter. In more than one third of cases (234 or 37.8%), the diagnosis was made in the third quarter of pregnancy. 113 cases (18.2%) of premature rupture of membranes, 10 cases (1.61%) of threat of premature delivery and 7 cases (11.13%) of placenta previa were registered. During labour, the diagnosis was made by clinical examination in 32.2% of cases. Bichorial biamniotic twin pregnancy was the most frequent anatomical type (62.6%). On admission, the first twin (T1) was in cephalic presentation in 56.7%, in breech presentation in 15.2%; The second twin (T2) was in breech presentation in 21.1% of the cases. Caesarean section was related to the first twin in 50.6% and the second twin in 53.8% of the cases. Caesarean section was performed in 50.6% for the first twin and in 53.8% for the second twin. The mean time interval between the delivery of T1 and that of T2 was 17.4 min. Low birth weight was more frequent for the second twin (54.3%). The stillbirth rate was 48.26 per thousand. Maternal complications were dominated by renal-vascular syndromes (4.2%), haemorrhagic causes (1.86%), perineal lesions (1.6%) and uterine rupture (0.97%). Postpartum haemorrhage was observed in 8 cases (1.29%). Maternal mortality was nilConclusions: Twin delivery poses varying difficulties due to the complexity of obstetrical mechanics and the frequency of dystocic presentations. Despite improved maternal prognosis, in recent years, perinatal mortality and morbidity, still high, remain a constant concern.


2017 ◽  
Vol 86 ◽  
Author(s):  
Boštjan Lovšin ◽  
Mladen Mrkajić ◽  
Janja Zver-Skomina ◽  
Dušan Deisinger

Background: Almost all babies in breech presentation at term are delivered by caesarean section. Professional guidelines recommend an attempt of external cephalic version to reduce breech presentations at birth and thus the proportion of caesareans. Our aim was to analyse the clinical and ultrasound factors to predict the outcome of version and check the hypothesis, if the implementation of the external cephalic version helps to reduce the number of caesareans.Methods: The study included all attempts of external cephalic version after 36 weeks of pregnancy at the Department of Obstetrics and Gynaecology in Izola General Hospital from 2002 to 2010.Results: 68/143 (47.6 %) external cephalic versions were successful. the success of intervention was mostly influenced by a greater amount of amniotic fluid, higher fetal position in the pelvis and transverse or oblique lie of the fetus. With 100 attempts of external cephalic version 32 caesareans were avoided or one cesarean per 3.1 attempts.Conclusions: the study has confirmed that by performing external cephalic version the number of caesareans can be reduced. The proportion of successful versions was comparable to studies in the literature despite the minimal use of uterine muscle relaxants.


2016 ◽  
Vol 2 (1) ◽  
pp. 153
Author(s):  
Tomescu Cezar Laurentiu ◽  
Rodica Sîrbu ◽  
Emin Cadar ◽  
Brezeanu Dragos ◽  
Aneta Tomescu

The incidence of breech presentation is approximately 3,97%. Breech presentation is considered as being “borderline eutocic” and it requires carefully monitoring both the foetus and the mother. The aim of the current paper is to evaluate the preffered method of delivery in case of breech presentation. The paper presents a retrospective study performed in the Obstetrics and Gynaecology Departments of the County Emergency Clinical Hospital “Sf. Apostol Andrei” in Constanta, during a period of 5 years (2010-2014). The methods of birth were analyzed for a lot of 1104 patients with breech presentation with ages ranging between 16 and 44 years old. The total number of patients who gave birth through vaginal delivery was of 139 patients, amounting to 12.59% of the total population sample. The number of patients that gave birth through C-section was 965, which amounts to 87.4% of the total population sample. Birth through C-section is preferred by both obstetricians and patients alike, due to the fact that vaginal delivery is associated with a higher foetal risk in breech presentation.


2018 ◽  
Vol 23 (suppl_1) ◽  
pp. e27-e27
Author(s):  
Sarah McKnight ◽  
Bishal Gautam ◽  
Michael Miller ◽  
Bryan S Richardson ◽  
Orlando da Silva

Abstract BACKGROUND The optimal mode of delivery for preterm infants remains controversial, and routine Caesarean sections (C/S) are not recommended, except for maternal indications. Nonetheless, many preterm infants are delivered by C/S, particularly those in breech presentation, and recent retrospective data have suggested that these infants may have improved outcomes. OBJECTIVES To examine whether C/S as the mode of preterm delivery is associated with decreased mortality and improved short term outcomes. DESIGN/METHODS This retrospective, population-based cohort study examined infants with a gestational age between 23 0/7 weeks and 32 6/7 weeks, born between January 1, 2007 and December 31, 2016, and admitted to the Neonatal Intensive Care Unit at a single Canadian Tertiary Care hospital. Infants with major congenital anomalies were excluded. Data were abstracted from the local Neonatal-Perinatal database for all infants. Two groups, those delivered vaginally and those delivered by C/S, were compared for major neonatal outcomes including the primary outcomes of death and severe intraventricular hemorrhage (IVH), defined as grade 3 or higher. RESULTS A total of 1442 infants met inclusion criteria (784 born by C/S and 658 vaginally). There was no significant difference in neonatal mortality (7.0% vs 7.1%, p=0.925) or severe IVH (6.1% vs 7.4%, p=0.317). There was, however, a significant difference in the incidence of IVH, any grade (19.9% vs 27.5%, p=0.001), which remained after controlling for other significant predictors. There were no other significant differences in the secondary outcomes examined including need for extensive resuscitation, respiratory distress syndrome, bronchopulmonary dysplasia, patent ductus arteriosus, necrotizing enterocolitis, periventricular leukomalacia, or retinopathy of prematurity. CONCLUSION Caesarean section was not associated with decreased mortality in preterm infants, relative to vaginal births. Caesarean section was associated with a reduced rate of IVH (any grade) and there was a trend towards decreased severe IVH which may warrant further study.


Author(s):  
Susheela Chaudhary ◽  
Parul Singh ◽  
Meenakshi B. ◽  
Anjali Gupta ◽  
Monika Ramola

The B-Lynch uterine suture brace is a relatively new technique used for treatment of postpartum haemorrhage. These uterine compression sutures have achieved hemostasis while preserving fertility in many women and thus their efficacy and safety have been time tested. Very few complications have been reported following B Lynch suture. These include Asherman’s syndrome, hematometra, pyometra, localized areas of uterine necrosis and full-thickness defects in the lower uterine segment or uterine fundus and erosion of uterine wall. Herewith, reporting a case of 23-year-old woman who underwent cesarean section for breech presentation. She had atonic PPH for which uterine artery ligation was done along with B-lynch suture. She developed uterine necrosis for which hysterectomy was done. Microsections showed that endometrial cavity was filled with gangrenous slough extending to variable extent in myometrium and cervix.


BMJ Open ◽  
2018 ◽  
Vol 8 (2) ◽  
pp. e019120 ◽  
Author(s):  
Sonja Wehberg ◽  
Rikke Guldberg ◽  
Kim Oren Gradel ◽  
Ulrik Schiøler Kesmodel ◽  
Lis Munk ◽  
...  

ObjectivesThe aim of this study was to estimate the effects of risk factors on elective and emergency caesarean section (CS) and to estimate the between-hospital variation of risk-adjusted CS proportions.DesignHistorical registry-based cohort study.Settings and participantsThe study was based on all singleton deliveries in hospital units in Denmark from January 2009 to December 2012. A total of 226 612 births by 198 590 mothers in 29 maternity units were included.Primary and secondary outcome measuresWe estimated (1) OR of elective and emergency CS adjusted for several risk factors, for example, body mass index, parity, age and size of maternity unit and (2) risk-adjusted proportions of elective and emergency CS to evaluate between-hospital variation.ResultsThe CS proportion was stable at 20%–21%, but showed wide variation between units, even in adjusted models. Large units performed significantly more elective CSs than smaller units, and the risk of emergency CS was significantly reduced compared with smaller units. Many of the included risk factors were found to influence the risk of CS. The most important risk factors were breech presentation and previous CS. Four units performed more CSs and one unit fewer CSs than expected.ConclusionThe main risk factors for elective CS were breech presentation and previous CS; for emergency CS they were breech presentation and cephalopelvic disproportion. The proportions of CS were stable during the study period. We found variation in risk-adjusted CS between hospitals in Denmark. Although exhaustive models were applied, the results indicated the presence of systematic variation between hospital units, which was unexpected in a small, well-regulated country such as Denmark.


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