scholarly journals Postpartum Uterine Wound Dehiscence Leading to Secondary PPH: Unusual Sequelae

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Rinku Sengupta Dhar ◽  
Renu Misra
Keyword(s):  
Caesarean Section ◽  
Conservative Management ◽  
Caesarean Delivery ◽  
Postpartum Haemorrhage ◽  
Wound Dehiscence ◽  
Abnormal Bleeding ◽  
Uterine Dehiscence

Secondary postpartum haemorrhage due to partial or complete dehiscence of uterine wound after caesarean section is unusual. Authors present here a patient with secondary postpartum haemorrhage following uterine dehiscence after caesarean delivery. Conservative management failed to control the bleeding, and she eventually needed hysterectomy. All women who have significant PPH following caesarean should undergo evaluation for any defect in the scar. Scar dehiscence has been diagnosed and repaired after many years of caesarean section in women with persistent abnormal bleeding. Therefore, this condition may have long-term implication if missed postpartum.

scholarly journals Which is better for pfannensteil skin incision closure in caesarean section? Interrupted mattress suture or continuous subcuticular suture

2020 ◽  
Vol 9 (9) ◽  
pp. 3711
Author(s):  
Shridevi A S. ◽  
Madhusoodana R. Bhovi ◽  
Prema Prabhudeva ◽  
Renuka . ◽  
Camelia Maitra
Keyword(s):  
Patient Satisfaction ◽  
Caesarean Section ◽  
Caesarean Delivery ◽  
Wound Closure ◽  
Wound Dehiscence ◽  
Skin Wound ◽  
Wound Complications ◽  
Skin Closure ◽  
Pain Level

Background: Caesarean delivery is one of the most commonly performed operations in obstetrics. Postoperative comfort of the woman largely depends on the method of skin closure. Wound complications from caesarean delivery such as dehiscence or infection cause a significant emotional and economic burden in obstetric care. There are many methods and techniques for skin wound closure in caesarean section. Each technique has its own advantages and disadvantages. The aim and objective of this study was to compare the wound outcomes in Pfannensteil incisions closed with mattress sutures using nonabsorbable suture and subcuticular sutures using absorbable sutures in caesarean deliveries.Methods: It is a prospective observational study done on 216 consecutive pregnant women who were admitted to labor room for elective or emergency caesarean section. Patients undergoing caesarean section with Pfannensteil incision between February 2019 to October 2019 were included in this study. Among 216 women, 108 women had mattress sutures and 108 women had subcuticular sutures for skin wound closure. The primary outcome studied was wound complications including erythema, wound dehiscence, burst abdomen, infection and pain which was studied on postoperative day 3-7. The secondary outcome was assessed at 6 weeks follow-up in terms of pain, cosmetic appearance of scar and patient satisfaction about scar.Results: A total of 216 pregnant women undergoing caesarean section were studied who had similar baseline characteristics and risk factors. However, women with previous caesarean section were more in mattress group. The overall incidence of erythema, surgical site infection, wound dehiscence, resuturing and pain was more in mattress group and was statistically significant. During follow-up at 6 weeks, women with subcuticular sutures had cosmetically better scar and more satisfied with their scars than women with mattress sutures but the pain level was same in both groups.Conclusions: Authors conclude that compared to mattress sutures, subcuticular sutures cause significantly fewer wound complications and pain in postoperative period. Also, subcuticular sutures are associated with cosmetically appealing scars and higher patient satisfaction. But there was no difference in pain level at 6 weeks in both methods of skin closure.

scholarly journals Rising trends and indication of Caesarean section in Indonesia

2020 ◽  
Vol 4 (1-2) ◽  
pp. 1
Author(s):  
Ali Sungkar ◽  
Ray Wagiu Basrowi
Keyword(s):  
Caesarean Section ◽  
Caesarean Delivery ◽  
Economic Status ◽  
Tertiary Care ◽  
Short Term ◽  
Policy Makers ◽  
National Surveys ◽  
Increasing Trend ◽  
Elective Procedure

The rate of Caesarean delivery is rising dramatically worldwide, and also nationally. The number of Caesarean births exceeds the WHO recommended rate. This study aims to provide an overview of current increasing trend of Caesarean section, including elective procedure, and its risk. A review was conducted using online database, surveillance reports, and national surveys to identify studies with topics of prevalence, trend, indications, and risks of Caesarean delivery. Overall, there is an increase of Caesarean section in global, Asia, and Indonesia setting. We found an increase of 8% from 2013 to 2018 based on population survey, and increase of elective Caesarean surgery, particularly in tertiary care. We listed the possible health risks in short term, long term among mothers and child. Advanced maternal age, higher socio-economic status, higher educational level, residing in urban area, and ownership of health insurance were found to be factors associated with maternal choice on Caesarean delivery. The information presented is important to raise awareness among policy makers aimed to develop a national strategy in reducing the rate of Caesarean delivery.

scholarly journals Multidetector Computed Tomography Evaluation of Uncommon Acute Post-Caesarean Section Complications

2021 ◽  
Vol 28 (2) ◽  
pp. E202127
Author(s):  
Musaib Ahmad Dar ◽  
Suhail Rafiq ◽  
Sheema Posh ◽  
Imran Wagay
Keyword(s):  
Computed Tomography ◽  
Caesarean Section ◽  
Multidetector Computed Tomography ◽  
Caesarean Delivery ◽  
Postpartum Haemorrhage ◽  
Ureteral Injury ◽  
Pelvic Sepsis ◽  
Safe Procedure ◽  
Management Of Complications ◽  
Acute Complications

Introduction. The most common major abdominal surgery in women is caesarean section. Despite being a safe procedure, a variety of complications, both acute and chronic, can occur. About 14.5% of caesarean sections result in complications. Infection followed by postpartum haemorrhage is the most frequent complication. Imaging modalities such as ultrasonography and multidetector computed tomography are often used in the evaluation of suspected uncommon post-caesarean complications. Computed tomography has been found to be a good initial modality for assessing acute postoperative complications after caesarean delivery. The objective of the research was to evaluate the imaging findings and the characteristic visual manifestations of atypical acute complications of caesarean section, other than common complications such as postpartum haemorrhage, wound infection, etc. Materials and Methods. This prospective study was carried out at the Department of Radiodiagnosis and Imaging, Government Medical College, Srinagar from June 2019 to February 2020 in collaboration with the Department of General Surgery and Gynaecology and Obstetrics of the Sher-i-Kashmir Institute of Medical Sciences. All patients with suspected complication in the immediate post-caesarean period were evaluated with contrast-enhanced multidetector computed tomography. Results. Out of 427 patients who underwent caesarean section, 25 patients were suspected of having uncommon acute complications. Out of 25 patients evaluated for suspected immediate post-caesarean complication, only 5 patients had bladder flap hematoma, 8 patients were diagnosed with uterine dehiscence, 6 patients had uterine rupture, 3 patients suffered from ureteral injury, 1 patient had gossypiboma, 2 patients developed pelvic sepsis. Conclusions. Multidetector computed tomography plays an important role in detection and confirmation of multiple acute complications after caesarean delivery and can also help in guiding the management of complications as well.

scholarly journals Indication and outcome of relaparotomy after caesarean section

2013 ◽  
Vol 45 (1-2) ◽  
pp. 19-23
Author(s):  
Sankar Prosad Biswas ◽  
Surovi Halder ◽  
Feroja Banu Shirin
Keyword(s):  
Caesarean Section ◽  
Caesarean Delivery ◽  
Postpartum Haemorrhage ◽  
Anterior Abdominal Wall ◽  
Rectus Sheath ◽  
Near Miss ◽  
Maternal Deaths ◽  
Uterine Arteries ◽  
Life Saving

The objective was to determine the indicatons, management and the outcome among the patient who underwent relaparotomy after caesarean section and to suggest the way to improve the quality of care. This was a retrospective descriptive study done in a tertiary level referral and teaching hospital, Khulna, Bangladesh, out of 55 cases requiring relaparotomy after caesarean section. Over a period of 15 months from 1st January 2011 to 31st march 2012, 1180 caesarean deliveries were done, out of total 3270 deliveries. During this period, relaparotomy was done in 55 cases. Among these, 10 cases followed caesarean delivery at this institute itself, while 45 cases have had caesarean delivery at peripheral hospitals. Postpartum haemorrhage in 31 cases (56.36%) and rectus sheath haematoma in 8 cases (14.55%) were the leading cause of relaparotomy. Among the 55 cases, 39 had emergency caesarean delivery while 16 had elective operation. Procedures undertaken at laparotomy were hysterectomy in 21 cases (38.18%), resuturing of uterine wound with uterine brace suture in 13 cases(23.63%), bilateral uterine arteries and ovarian vessels ligation in 7 cases (12.73%), drainage of haematoma in 8 cases (14.55%), and repair of anterior abdominal wall & peritoneal toileting in 5 cases (9.09%). A third laparotomy was done in 3 cases of which 2 cases were due to secondary PPH, a negative relaparotomy was done in one case. There were 7 maternal deaths following relaparotomy caused by hemorrhagic shock, septicaemia & renal failure and was 12.73%. Caesarean section is a life saving operation. However maternal mortality and near miss fatality after relaparotomy following caesarean section are common. So, relaparotomy should be considered as a procedure after a near miss fatality of mother. DOI: http://dx.doi.org/10.3329/bmjk.v45i1-2.13625 Bang Med J (Khulna) 2012; 45 : 19-23

scholarly journals Relaparotomy after Cesarean Section : Experience from a Tertiary Referral and Teaching Hospital of Bangladesh

1970 ◽  
Vol 24 (1) ◽  
pp. 3-9
Author(s):  
Salma Rouf ◽  
Sebera Sharmin ◽  
Farhana Dewan ◽  
Salma Akhter
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Teaching Hospital ◽  
Caesarean Delivery ◽  
Rectus Sheath ◽  
Case Fatality ◽  
Wound Dehiscence ◽  
Near Miss ◽  
Tertiary Referral ◽  
College Hospital

Objectives: The objective of the study was to find out the incidence, indications, risk factors and outcomes of cases requiring relaparotomy following caesarean delivery during the puerperium. Material and Methods: This was a retrospective descriptive study set in a tertiary referral and teaching hospital ( Dhaka Medical College Hospital) in Dhaka, capital of Bangladesh. Results: Over a period of one year from January 1st to 31st December 2007, there were 3830 caesarean deliveries (48.43%) out of a total of 7909 deliveries. Relaparotomy was done in 24 patients (0.63%) of the caesarean sections. The indications of repeat laparotomy were secondary postpartum haemorrhage (PPH) in 11 cases(45.8%), primary PPH due to uterine atony in 8 cases (33%), uterine sepsis with haemorrhage in 1 case (4.17%), rectus sheath haematoma in 2 cases (8.3%), internal haemorrhage after caesarean section in 1 case (4.17%) and abdominal wound dehiscence in 1 case (4.17%). Of these 24 cases, in 4 cases, primary caesarean section was done in this institution while 20 had caesarean delivery at other hospitals and clinics at (5 cases) and outside Dhaka (15 cases). Main surgeries performed at relaparotomy were subtotal hysterectomy in 12 cases, total hysterectomy in 5 cases, drainage of haematoma and peritoneal toileting in 2 cases, resuturing of uterine incisions in 1 case, ligation of uterine vessels in 2 cases and internal iliac arteries in 1 case and others. More than one procedure was often performed in one case. There were 6 maternal deaths following relaparotomy caused by shock following PPH, septicaemia and internal haemorrhage. Conclusion: Repeat laparotomy within six weeks of caesarean delivery was required 1 in 200 cases in this institute. Case fatality rate was high (25%). Near miss fatalities were also common. Majority of these were preventable. Identification of risk factors, adequate attention during primary surgery, expert decision, prompt intervention and proper case management during relaparotomy will improve the outcome. Key words: Caesarean delivery; relaparotomy. DOI: 10.3329/bjog.v24i1.6319 Bangladesh J Obstet Gynaecol, 2009; Vol. 24(1) : 3-9

Long-term outcomes of lumbar microdiscectomy in the pediatric population: a large single-institution case series

2019 ◽  
Vol 24 (5) ◽  
pp. 549-557
Author(s):  
Malia McAvoy ◽  
Heather J. McCrea ◽  
Vamsidhar Chavakula ◽  
Hoon Choi ◽  
Wenya Linda Bi ◽  
...  
Keyword(s):  
Conservative Management ◽  
Functional Outcomes ◽  
Pediatric Patients ◽  
Clinical Presentation ◽  
Case Series ◽  
Csf Leak ◽  
Single Institution ◽  
The Mean

OBJECTIVEFew studies describe long-term functional outcomes of pediatric patients who have undergone lumbar microdiscectomy (LMD) because of the rarity of pediatric disc herniation and the short follow-up periods. The authors analyzed risk factors, clinical presentation, complications, and functional outcomes of a single-institution series of LMD patients over a 19-year period.METHODSA retrospective case series was conducted of pediatric LMD patients at a large pediatric academic hospital from 1998 to 2017. The authors examined premorbid risk factors, clinical presentation, physical examination findings, type and duration of conservative management, indications for surgical intervention, complications, and postoperative outcomes.RESULTSOver the 19-year study period, 199 patients underwent LMD at the authors’ institution. The mean age at presentation was 16.0 years (range 12–18 years), and 55.8% were female. Of these patients, 70.9% participated in competitive sports, and among those who did not play sports, 65.0% had a body mass index greater than 25 kg/m2. Prior to surgery, conservative management had failed in 98.0% of the patients. Only 3 patients (1.5%) presented with cauda equina syndrome requiring emergent microdiscectomy. Complications included 4 cases of postoperative CSF leak (2.0%), 1 case of a noted intraoperative CSF leak, and 3 cases of wound infection (1.5%). At the first postoperative follow-up appointment, minimal or no pain was reported by 93.3% of patients. The mean time to return to sports was 9.8 weeks. During a mean follow-up duration of 8.2 years, 72.9% of patients did not present again after routine postoperative appointments. The total risk of reoperation was a rate of 7.5% (3.5% of patients underwent reoperation for the same level; 4.5% underwent adjacent-level decompression, and one patient [0.5%] ultimately underwent a fusion).CONCLUSIONSMicrodiscectomy is a safe and effective treatment for long-term relief of pain and return to daily activities among pediatric patients with symptomatic lumbar disc disease in whom conservative management has failed.

scholarly journals Adhesive Small Bowel Obstruction and the six w’s: Who, How, Why, When, What, and Where to diagnose and operate?

2021 ◽  
pp. 145749692098276
Author(s):  
M. Podda ◽  
M. Khan ◽  
S. Di Saverio
Keyword(s):  
Small Bowel ◽  
Small Bowel Obstruction ◽  
Bowel Obstruction ◽  
Conservative Management ◽  
Bowel Ischemia ◽  
Current Evidence ◽  
First Episode ◽  
Adhesive Small Bowel Obstruction ◽  
Highly Effective

Background and Aims: Approximately 75% of patients admitted with small bowel obstruction have intra-abdominal adhesions as their cause (adhesive small bowel obstruction). Up to 70% of adhesive small bowel obstruction cases, in the absence of strangulation and bowel ischemia, can be successfully treated with conservative management. However, emerging evidence shows that surgery performed early during the first episode of adhesive small bowel obstruction is highly effective. The objective of this narrative review is to summarize the current evidence on adhesive small bowel obstruction management strategies. Materials and Methods: A review of the literature published over the last 20 years was performed to assess Who, hoW, Why, When, What, and Where diagnose and operate on patients with adhesive small bowel obstruction. Results: Adequate patient selection through physical examination and computed tomography is the key factor of the entire management strategy, as failure to detect patients with strangulated adhesive small bowel obstruction and bowel ischemia is associated with significant morbidity and mortality. The indication for surgical exploration is usually defined as a failure to pass contrast into the ascending colon within 8–24 h. However, operative management with early adhesiolysis, defined as operative intervention on either the calendar day of admission or the calendar day after admission, has recently shown to be associated with an overall long-term survival benefit compared to conservative management. Regarding the surgical technique, laparoscopy should be used only in selected patients with an anticipated single obstructing band, and there should be a low threshold for conversion to an open procedure in cases of high risk of bowel injuries. Conclusion: Although most adhesive small bowel obstruction patients without suspicion of bowel strangulation or gangrene are currently managed nonoperatively, the long-term outcomes following this approach need to be analyzed in a more exhaustive way, as surgery performed early during the first episode of adhesive small bowel obstruction has shown to be highly effective, with a lower rate of recurrence.

scholarly journals Conservative management of delayed presentation of intraperitoneal bladder rupture following caesarean delivery: A case report

2019 ◽  
Vol 59 ◽  
pp. 31-34 ◽  
Author(s):  
Ismaeel Aghaways ◽  
Rawa Bapir ◽  
Tahir A. Hawrami ◽  
Nishtman M. Thahir ◽  
Mohammed Abed Al Kadum Hassan ◽  
...  
Keyword(s):  
Case Report ◽  
Conservative Management ◽  
Caesarean Delivery ◽  
Bladder Rupture ◽  
Delayed Presentation ◽  
Intraperitoneal Bladder Rupture

STUDY OF OBSTETRIC OUTCOMES IN ELECTIVE AND EMERGENCY CAESAREAN SECTION IN PATIENTS WITH PRIOR LOWER SEGMENT CAESAREAN SECTION

2021 ◽  
pp. 57-60
Author(s):  
Dipak S. Kolate ◽  
Meenal M. Patvekar ◽  
Shriraj Katakdhond ◽  
Yogesh Thawal ◽  
Kale DhanaLaxmi ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Perinatal Outcome ◽  
Maternal Morbidity ◽  
Caesarean Delivery ◽  
Emergency Caesarean Section ◽  
Obstetric Outcomes ◽  
Fetal Outcomes ◽  
Emergency Caesarean ◽  
Management Protocol ◽  
History Of

Background:Acomprehensive study of maternal morbidity and mortality with perinatal outcome in patients with prior LSCS undergoing elective or emergency caesarean section was carried out. With the sky rocketing caesarean section rates worldwide an increasing number of women face the issue of mode of delivery in their current pregnancy. There are conicting reports regarding the safety of a trial for vaginal birth after caesarean delivery (VBAC) in terms of uterine rupture, maternal and perinatal morbidity. The purpose of this study was to evaluate the obstetric and fetal outcomes of patients presenting at term with a history of previous one or more LSCS. Methods:Asix months prospective, observational study was conducted where all patients who had a term pregnancy with a history of previous one or more LSCS were included after obtaining their consent for participation. The obstetric and fetal outcomes of these patients with elective or emergency LSCS in the present pregnancy were noted and tabulated. Adescriptive analysis of these outcomes was carried out. Results: 100 Patients at term, with a history of previous one or more LSCS were studied. 38 patients underwent an elective repeat caesarean delivery and 62 in emergency.Scar dehiscence was seen in 35.5 % of the patients who were presented in emergency with uterine contractions or lower abdominal pain and those were not candidate for a trial for VBAC.All of the complications were signicantly higher in emergency group in terms of both maternal (83.9 % Vs 31.6%) and perinatal outcome (6.5% Vs 0 %). Conclusion:With an increase in the proportion of patients with a history of previous LSCS, it is essential for health care institutions to have proper antenatal counseling regarding plan of delivery and vigilance while operating patients with prior history of LSCS , especially in emergency situation. There should be a well dened management protocol in an effort to decrease the number of complications and bring down the overall maternal morbidity & mortality .

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