Our study shows that vaginal birth after a prior caesarean section has decreased over time in Switzerland. There was no significant change in labour induction during the study period. While this trend might reflect an increasing demand for safety in pregnancy and childbirth, it concomitantly increases maternal risks of further pregnancies, and women need to be appropriately informed about long-term risks.
Purpose of the study Mother-to-child transmission rates in Europe are below 1% in HIV-infected women on successful combined antiretroviral therapy (cART) irrespective of mode of delivery. Consequently, most national guidelines updated between 2001 and 2009 recommended vaginal deliveries for women with undetectable or very low viral load (VL). The aim of this study was to explore the impact of these new guidelines on the rates of vaginal deliveries following complete viral suppression on cART. Methods A pooled analysis of data on HIV-1-positive women enrolled in the Swiss Mother & Child HIV Cohort Study and the European Collaborative Study with a live birth between 2000 and 2010 was carried out. Deliveries were classified as occurring pre- or post-publication of national guidelines recommending vaginal delivery in women with low/ undetectable VL for each country. Summary of results Overall, 2527 mothers, 2848 deliveries and 2903 births were included from 10 countries. The women were mostly Caucasian (44%) or black (47%) and had a median age of 31 at the time of delivery. They were diagnosed with HIV a median of 3.3 years before pregnancy and 84% were CDC stage A with a median CD4 cell count of 450 cells/mm3. 17% reported a history of injecting-drug use (IDU) and 3% current IDU. 29% of women conceived on cART, 63% started in pregnancy and 8% received no antenatal ART. The most common regimen used was PI based cART (50%). Of the deliveries, elective caesarean section (CS) was carried out in 58%, emergency CS in 17% and vaginal delivery in 23%. Of 1869 women with a VL measure within the last trimester of pregnancy, only 65% had undetectable HIV-RNA. Overall, 21% of all deliveries occurring before the guideline change were vaginal, increasing to 48% subsequently. The proportion of women with undetectable VL having a CS decreased from 29% before to 13% after the guidelines update. Conclusions Nearly half of all deliveries subsequent to European guideline changes were vaginal. Nevertheless, there are missed opportunities to achieve fully suppressed viral load at time of delivery and to deliver vaginally in HIV infected women. Further evaluation of treatment regimens, adherence data and barriers to treatment is planned within these cohorts
We describe the case of a 23-year-old nulligravid woman who complained of increasing post-menstrual lower abdominal pain. She used contraceptives permanently for three months and was referred with a sub-mucosal lesion suspicious for a type 2 fibroid to be resected. During hysteroscopy, no fibroid mass could be confirmed. A postoperatively performed ultrasound including hydrosonography demonstrated a lesion highly suspicious for a uterus unicollis with a non-communicating uterine horn and a haematometra. Laparoscopy confirmed a normal outer lining of the uterus with hypoplastic tube on the right side. Referring to pre-operative findings, a broadly based uterine horn including a large haematometra was diagnosed. We performed a laparoscopic resection of the rudimentary horn and a right salpingectomy. The patient could be discharged without any complications three days later.
In 24 patients with malignant kidney tumours percutaneous embolizations of the arteria renalis were performed in about 1 year. The material for embolization was gelatine-sponge-particles. The embolization was done pre-operatively, usually in connection with the arteriographie examination of kidney tumours (hypernephroid carcinoma). In 2 patients without operation it was done as a palliative measure. Our favourable results to improve the operability of tumours agree with reports in the literature. According to our opinion the pre-operative embolization of the arteria renalis with kidney tumours offers the possibility of a blood-sparing operation and a reduction of tumour-cell outwashings.
To describe the longitudinal changes in maternal cardiac function during uncomplicated twin pregnancy. Materials and methods: In a series of twin viable pregnancies cardiac output (CO) and total vascular resistance (TVR) were longitudinally calculated at 20-23, 26-29 and 30-33 weeks of gestation. Cardiac output was measured by continuous-wave Doppler at the aortic valve. Patients were excluded with any of the following: delivery prior to 36 completed weeks; ascertained fetal anomalies; history of maternal disease or hypertensive disorder, perinatal death, IUGR of one or both newborns (birthweight < 5th percentile); maternal preeclampsia. In all cases delivery was electively performed by scheduled Cesarean section between 36 and 37 weeks. Results: Overall nine pregnancies were enrolled in the study.
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