Key content The incidence and presentation of complications of caesarean section. The surgical management of intrapartum and postpartum haemorrhage. Risk factors for, and prevention and treatment of postpartum sepsis. Presentation, investigation and repair of bladder injuries when recognised intraoperatively and following delayed presentation. Risk factors for, and recognition and management of suspected ureteric injury intraoperatively and postoperatively. Bowel complications including intraoperative bowel injury and management, postoperative ileus and Ogilvie syndrome. Particular risks and complications associated with caesarean section at full dilatation. Caesarean section in the developing world. Learning objectives To be aware of the most common and serious complications of caesarean section. To be able to describe recognition and initial surgical management of suspected bladder, ureteric and bowel injuries. To be familiar with delayed presentations of visceral injuries and have a systematic approach to investigation of suspected injury. To understand the impact of caesarean section complications in resource‐poor countries. Ethical issues Appropriate, accurate preoperative counselling regarding risks and consent. Awareness of personal competency in managing specific complications.
Objectives The aim of the study was to analyze the clinical features of women found to have vaginal intraepithelial neoplasia (VaIN), the treatment modalities that they were offered, and clinical outcomes after treatment and follow-up. Materials and Methods This is a retrospective review of all cases of biopsy-proven or treated VaIN occurring for a 15-year period at Southend University Hospital, United Kingdom. Results Eighty-eight cases of VaIN were identified. The age range was from 24 to 76 years, and 39% of cases were low grade (VaIN 1) and 60% high grade (VaIN 2 and 3). Sixty-five percent of patients had either already undergone or would go on to have treatment for cervical intraepithelial neoplasia. Of those with low-grade disease, 86% were managed conservatively with a 97% success rate. Similarly, with high-grade disease, 77% were managed with laser treatment with a success rate of 76% for primary treatment. Of the 6 cases of high-grade disease treated conservatively, 50% subsequently needed active treatment. There was 1 case of progression to vaginal cancer (1.3%). Conclusions Vaginal intraepithelial neoplasia remains an uncommon premalignant condition. It can affect women of all ages and is commoner in those who are immunosuppressed. Observation of low-grade disease is safe and the abnormality often resolves spontaneously. For persistent disease or higher-grade abnormalities, there are many treatment options but laser vaporization is the most commonly used. However, because of the nature of VaIN, recurrence is common even after treatment and further management can be challenging. The overall rate of malignant progression is small but protracted follow-up may be necessary.
The health benefits of breastfeeding are well known; the majority of women in the UK express a desire to breastfeed. However, by 8 weeks of age, only 40% of babies are receiving any breastmilk. Many reasons are given for discontinuing, but GPs, as a primary contact for women concerned about breastfeeding, are often able to identify problems. The aim of this article is to explore what constitutes successful breastfeeding, common concerns expressed by mothers, the pathologies with which they present to GPs and how breastfeeding fits into a holistic picture of postnatal health.
Background Preventable neonatal admissions are an unnecessary expense to hospital trusts, a traumatic experience for families and put neonates at increased risk of hospital acquired infection. Aims To assess the incidence of neonatal readmissions to a London paediatric department and to analyse the diagnosis & management of neonates re-admitted with feeding problems. From this we aim to observe any correlation between length of birth stay and length of readmission stay. Methods A retrospective audit was conducted on all infants (≤ 28 days) that were readmitted between Oct 2011–Oct 2012. A review of the paper notes and discharge summaries was carried out for all those with a primary diagnosis code including ‘feeding’. Results A total of 266 (8% of a total of 3308 paediatric admissions) neonates were re-admitted over 13 month period. 42 had a primary diagnosis of feeding problems. 36 of these notes were available for analysing. 26 (72%) readmitted under 1 week of age. The 3 most common presenting complaints were reduced feeds, weight loss and jaundice. An organic cause was found in only 4 cases. There was a small positive correlation between length of birth stay and length of readmission stay. The most common intervention was a feeding plan given to 33 (92%), followed by feeding advice and counselling (22%) and antibiotics (17%). The admission versus discharge mode of feeding showed a drop in breast feeding from 61% to 3% and an increase in mixed feeding (breast and bottle) from 25% to 72%. Conclusion Better community support around neonatal feeding particularly in the first week of life could reduce the number of preventable neonatal readmissions. Hospital based treatment for feeding problems is likely to result in a change in feeding method away from breastfeeding alone.
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