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Summary: A case of 4 true knots in an umbilical cord, which did not cause any detectable harm, is presented. Careful examination of the placenta, membranes and umbilical cord continues to be encouraged. 相似文献
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Efficacy of Bupivacaine Delivered by Wound Catheter for Post-Caesarean Section Analgesia 总被引:4,自引:0,他引:4
David W. J. Mecklem FANZCA Michael D. Humphrey FRACOG FRCOG Ross W. Hicks DipRACOG 《The Australian & New Zealand journal of obstetrics & gynaecology》1995,35(4):416-421
Summary: A prospective, randomized, double-blind trial was conducted to assess contribution to postoperative analgesia of intermittent instillation of 0.25% bupivacaine beneath the rectus sheath in 70 women delivered by lower uterine segment Caesarean section. The operations were performed via a Pfannenstiel incision under spinal anaesthesia. Background intravenous narcotic analgesia was provided with a patient controlled analgesia system (PCAS) using a standard morphine regimen.
Overall (44 hr) mean morphine consumption was significantly greater in the placebo (saline) group compared to the treatment group (84.2 mg versus 63.3 mg. Two tailed t test p<0.001). The most significant intergroup differences in narcotic use were found in the first 4 hours and between 24 and 36 hours after commencing PCAS (Two tailed t test p=0.014 and 0.003 respectively).
Subjective pain scores were assessed with a 10 cm visual analogue scale (VAS). The mean peak VAS score was greater in controls (5.37) than the treatment group (4.25) between 18 and 24 hours postoperatively (Mann-Whitney U=424, p=0.027). There were no intergroup differences in pain scores for any other time period. The overall incidence of nausea was lower in the treatment group compared to the control group (Chi squared with Yates' correction p=0.046) and a lower degree of sedation was seen in those receiving bupivacaine between 4 and 8 hours after commencing PCAS (Mann-Whitney U=427, p=0.028). No differences in other narcotic related side-effects (vomiting and pruritus) were shown between groups.
Regular instillation of 0.25% bupivacaine beneath the rectus sheath of women delivered by Caesarean section reduces their morphine requirements by 25% in the 44 hours after operation, with an associated reduction in both nausea and early sedation. 相似文献
Overall (44 hr) mean morphine consumption was significantly greater in the placebo (saline) group compared to the treatment group (84.2 mg versus 63.3 mg. Two tailed t test p<0.001). The most significant intergroup differences in narcotic use were found in the first 4 hours and between 24 and 36 hours after commencing PCAS (Two tailed t test p=0.014 and 0.003 respectively).
Subjective pain scores were assessed with a 10 cm visual analogue scale (VAS). The mean peak VAS score was greater in controls (5.37) than the treatment group (4.25) between 18 and 24 hours postoperatively (Mann-Whitney U=424, p=0.027). There were no intergroup differences in pain scores for any other time period. The overall incidence of nausea was lower in the treatment group compared to the control group (Chi squared with Yates' correction p=0.046) and a lower degree of sedation was seen in those receiving bupivacaine between 4 and 8 hours after commencing PCAS (Mann-Whitney U=427, p=0.028). No differences in other narcotic related side-effects (vomiting and pruritus) were shown between groups.
Regular instillation of 0.25% bupivacaine beneath the rectus sheath of women delivered by Caesarean section reduces their morphine requirements by 25% in the 44 hours after operation, with an associated reduction in both nausea and early sedation. 相似文献
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Tsungai Chipato MRCOG David L. Healy PhD FRACOG Beverley Vollenhoven MRACOG Helen M. Buckler MRCP 《The Australian & New Zealand journal of obstetrics & gynaecology》1991,31(4):383-384
We present these 3 cases to alert others to the possibility of severe pain with rapid shrinkage of fibroids occurring during LHRH analogue treatment. We suggest management of such events should not be surgical except for vaginal excision of prolapsed fibroid polyps. 相似文献
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Christopher Del Mar FRACGP FAFPHM Vivienne O'Connor FRACOG 《The Australian & New Zealand journal of obstetrics & gynaecology》1994,34(1):35-38
Summary: We questioned 229 general practitioners (GPs), 288 women who had recently delivered babies in public hospitals, 26 public hospital doctors, and 33 midwives in South Brisbane. Shared antenatal care was undertaken by 84% of mothers, and recently provided by 88% GPs. Mothers valued having sufficient time with their antenatal clinician, continuity of care, and short waiting and travel times. They preferred a GP to provide antenatal care, and a hospital midwife to deliver them. GPs were interested in providing even more obstetric care - one third in providing intrapartum care - and in gaining continuing education in obstetrics. Hospital doctors and midwives were supportive of women choosing the personnel to deliver them, and of an increased GP and midwife role in public hospital obstetrics, but unenthusiastic about home deliveries. There is widespread support for an increased role for GPs in public obstetrics. 相似文献
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John D.P. Bowditch FRCOG FRACOG 《The Australian & New Zealand journal of obstetrics & gynaecology》1994,34(5):614-615
Summary: Heterotopic pregnancy is being encountered more commonly after assisted reproductive techniques. A case of heterotopic pregnancy after spontaneous conception is reported. Clinician based ultrasound to reveal an indirect ultrasound sign suggesting the condition was utilized. The case was managed successfully by laparoscopic partial salpingectomy. 相似文献
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David S. Browne FRCOG FRACOG Malcolm I. Frazer MD MRCOG 《The Australian & New Zealand journal of obstetrics & gynaecology》1991,31(2):148-152
This paper summarizes the results obtained in 279 vaginal hysterectomies performed in the 5 years 1985-1989 in the public and private practices of a single gynaecologist. It is suggested that it is feasible and safe to perform a hysterectomy vaginally in preference to the abdominal route in the majority of women, even in the absence of uterine descent. It is essential that registrars in training continue to be thoroughly versed in the techniques of vaginal surgery if such techniques are not to be forgotten. 相似文献
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Ectopic Pregnancy in Lower Segment Uterine Scar 总被引:19,自引:0,他引:19
H. Roberts FRACOG COGUS C. Kohlenber FRACOG DDU V. Lanzarone MRACOG H. Murray FRACOG 《The Australian & New Zealand journal of obstetrics & gynaecology》1998,38(1):114-116
Summary: A case of ectopic pregnancy in a lower uterine segment scar following previous Caesarean section is reported. A significant scar defect may result in deep implantation within the myometrium with the risk of persistent pain and bleeding followed inevitably by uterine rupture. In this report we discuss a number of management options. Except in the special situation of superficial implantation in a shallow scar defect where there is ultrasound evidence of continuity of the gestational sac with the uterine cavity we would strongly advise termination of the pregnancy. 相似文献
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Transcervical Resection of the Endometrium Using Intracervical Block Only A Review of 278 Procedures
James Ferry FRACOG Lloyd Rankin FRCOG 《The Australian & New Zealand journal of obstetrics & gynaecology》1994,34(4):457-461
Summary: The objective of this study was to assess the efficacy and safety aspects of performing transcervical endometrial resection (T.C.R.E.) on a selected group of 278 patients with menstrual disorders under local analgesia (intracervical block) only. Patient acceptance of the procedure was high, with only 3 cases not completed due to insufficient analgesia (1.07%), although a further 9 (3.2%) were completed with the help of intravenous sedation. Patient satisfaction at 4 months was 90%. There were 4 perforations (1.4%), but no laparotomy was required. Five cases (1.7%) of haemorrhage required a Foley catheter, with 1 needing a transfusion. There was no case of clinically evident glycine overload. Twelve patients required an overnight stay.
Patient acceptance of T.C.R.E. under local analgesia, and the incidence of major complications, compared favourably with other published series, including a series of 330 cases performed concurrently by the same operators under general anaesthesia. 相似文献
Patient acceptance of T.C.R.E. under local analgesia, and the incidence of major complications, compared favourably with other published series, including a series of 330 cases performed concurrently by the same operators under general anaesthesia. 相似文献