A retrospective case-review of 52 mothers who had a peripartum hysterectomy over the past 27 years was conducted at the Rotunda hospital, Dublin, Ireland. The chief indications were uncontrollable haemorrhage due to rupture of the uterus, placenta praevia and uterine atony. Obstetric hysterectomy is a formidable operation, usually performed as a life-saving measure and requires expert surgical dexterity in order to minimise the significant morbidity. The benefits of the subtotal operation appear to be superior to those of total hysterectomy. Counselling patients having a caesarean section regarding the possibility of hysterectomy is advisable in those who have had previous uterine surgery, multiple caesarean sections or placenta praevia.
The aim was to assess the maternal and fetal outcome in women who had labour induced for anhydramnios after 37 completed weeks of gestation. A retrospective study was conducted at the Rotunda Hospital from 1 January 2003 to 31 December 2007. All women with anhydramnios at term were identified from a review of ViewPoint® (computer software for antenatal scans performed), hospital data and the labour ward register. All women with a history of previous lower segment caesarean section (LSCS), current significant medical illness such as diabetes, hypertension, pre-eclampsia or ruptured membranes were excluded because the aim of the study was to focus specifically on low risk pregnancies with an incidental diagnosis of anhydramnios after 37 weeks' gestation. The maternal and fetal outcome parameters reviewed included: maternal age, parity, gestation, method of induction, mode of delivery, Apgar score and the requirement for obstetric or neonatal intervention. This study showed that anhydramnios is associated with a 56.6% LSCS rate in primigravida and a 19.0% LSCS rate in multigravida. Our study did not show any significant neonatal morbidity and there were no cases of mortality.
Pre-eclampsia remains an enigma despite extensive research. It is a common obstetric disorder and has multi-system ramifications. Previous research has concluded that the parameters of forced spirometry remain unchanged in normal pregnancy compared with non-pregnant controls. This study revealed that pre-eclampsia significantly alters lung function and implies that non-pregnant spirometric normograms may not reliably reflect concomitant pulmonary disease in such women.
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