-
[show abstract]
[hide abstract]
ABSTRACT: To determine if blunt or sharp expansion of the uterus at caesarean delivery is associated with increased maternal peripartum haemorrhage as estimated by the drop in hematocrit. Prospective randomised intention to treat clinical trial of women undergoing elective or urgent caesarean delivery at at least 36 weeks gestation. Two study groups were formed; after an initial hysterotomy which consisted in a transverse uterine incision of the lower segment, in the blunt group, the surgeon's indexes expanded the initial incision bilaterally and cephalad; in the sharp group, expansion of the initial incision was made using scissors. The primary outcome measure was the mean drop in hematocrit and p < 0.05 was considered significant. Three hundred women were randomised: 153 to the sharp group and 147 to the blunt group. The demographic and clinical characteristics of the two populations were similar. There were no statistically significant differences between the groups in estimated blood loss as assessed by the mean drop in hematocrit (%) (respectively 1.71 +/- 3.18 versus blunt group 1.91 +/- 3.28 p = 0.58 non significant). Our findings support that sharp or blunt expansion of hysterotomy during caesarean section equally affect blood loss as estimated by drop in hematocrit.
Revue médicale de Liège 04/2007; 62(4):235-8.
-
[show abstract]
[hide abstract]
ABSTRACT: We report the anaesthetic management of a 32-year-old pregnant women with aortic dissection and Marfan syndrome for caesarean section. The patient has presented at 31 weeks gestation of a first pregnancy an aortic dissection that required an emergency aortic replacement. Three years later, she presented at 31 weeks gestation with aortic dissection, mitral valve dysfunction and acute pulmonary oedema. She was treated in intensive care unit with deslanoside, diuretic and twice a day echographic examination. Delivery was planned by caesarean section after haemodynamic stabilisation on the sixth day. Combined spinal and epidural anaesthesia was performed after monitoring. The initial intrathecal injection of bupivacaine, morphine and fentanyl provided rapid onset of analgesia. Epidural anaesthesia was used with diluted lidocaine and fentanyl boluses. With appropriate preoperative care and monitoring, uneventful combined spinal and epidural anaesthesia for Caesarean section was achieved in a patient with Marfan syndrome in the presence of aortic dissection complicated by mitral valve dysfunction and acute pulmonary oedema.
Annales Françaises d Anesthésie et de Réanimation 11/2002; 21(8):672-5. · 0.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Evaluation of severe maternal morbidity in peripartum period leading to controlled ventilation in the obstetrical intensive care unit.
A retrospective study was carried out during a period of three years, from March 1998 to March 2001, in the obstetrical intensive care unit (ICU) of Farhat Hached hospital, Sousse (Tunisia).
Twenty obstetric patients requiring controlled ventilation were admitted in the ICU. Obstetric data included maternal age, gestational age, parity, diagnosis of the disease requiring controlled ventilation and maternal outcome.
A total of 24812 deliveries occurred during the study period at Farhat Hached maternal center. Twenty patients (0.08 percent) required controlled ventilation for a mean duration of 38 hours (range: five hours- 21 days). The mean age was 30 +3 years. Eight patients were primigravida. The mean gestational age was 33 +2 weeks. Seventeen patients (85 percent) underwent cesarean section. The mean duration in the ICU was six days (range: 5 hours - 34 days). There were six maternal deaths (30 percent). Maternal mortality was attributed to neurologic 40 percent, hemodynamic 30 percent or respiratory 30 percent failure which complicated eclampsia, hemorrhagic shock, pulmonary edema or sepsis.
There were 0.08 percent of obstetric patients requiring controlled ventilation. The serious maternal morbidity and the high mortality require better care of obstetric patients.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 06/2002; 31(3):256-60. · 0.42 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Our purpose was to describe the effects of serious obstetric complications on maternal and perinatal outcome in pregnancies complicated by Hellp syndrome.
Retrospective study.
Sixteen patients managed from January 1994 through December 1998 in whom pregnancy was complicated by Hellp Syndrome.
The incidence of Hellp syndrome among women with severe preeclampsia and/or eclampsia (164 cases) was 9.7%. Fourteen cases occurred before and two after delivery. In nine cases, Hellp occurred before 32 weeks of gestation and later in two other cases. Mean gestational age at delivery was 32.4 weeks. Serious maternal morbidity included acute renal failure (five cases), disseminated intravascular coagulation (two cases), pulmonary oedema (one case), severe ascites (five cases), pleural effusion (three cases), adult respiratory distress syndrome (one case). Abruptio placenta, acute renal failure and disseminated intravascular coagulation were always associated. Ten patients required transfusions with blood products. Caesarean delivery was performed in 15 cases. General anaesthesia was used in all patients. There was one maternal death from multiple organ failure. Perinatal outcome was poor. Six perinatal deaths were related to abruptio placenta, intrauterine asphyxia and extreme prematurity.
The high maternal and perinatal mortality and morbidity reported with the presence of Hellp syndrome requires maternal-fetal follow-up in a tertiary centre where intensive maternal and neonatal care are available.
Annales Françaises d Anesthésie et de Réanimation 01/2001; 19(10):712-8. · 0.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report a retrospective analysis of four cases of peripartum cardiomyopathy admitted, within a 10-year period, to the maternity hospital of Sousse. The age of the patients was over 30 years, two had gemellary pregnancies and two suffered toxaemia. Congestive cardiac failure, mainly of the left ventricle, with acute pulmonary oedema, was the main symptom. Chest X-ray showed a cardiothoracic index above 0.58 and echocardiography a left ventricular telediastolic diameter above 5.7 cm and a shortening ratio of 25% or less. Endomyocardial biopsy for ascertaining the diagnosis was not available. Treatment included bed rest, water and salt restriction, digitalis, a diuretic and an anticoagulant in case antepartum cardiomyopathy, a converting enzyme inhibitor and a diuretic in case of postpartum cardiomyopathy. Three patients recovered totally and in one echocardiography showed a persisting impaired left ventricular function. Five neonates had a favourable outcome and one foetus died in utero. Main problems raised by peripartum cardiomyopathy are discussed.
Annales Françaises d Anesthésie et de Réanimation 07/1999; 18(6):677-82. · 0.84 Impact Factor
-
La Tunisie médicale 12/1998; 76(11):376-9.
-
K Monastiri,
A Chaieb,
H Skouri, A Slama,
S Chebil,
R Maaroufi,
M Nouira,
M Mokni,
R Zanina,
H Saidi,
F Ben Amor,
M Bibi,
T Mahjoub,
M Kortas,
N Snoussi,
H Khairi
La Tunisie médicale 12/1996; 74(12):578-84.
-
[show abstract]
[hide abstract]
ABSTRACT: This study was conducted to evaluate the effect of antibiotic prophylaxy on decreasing the frequency of postoperative infections after cesarean sections performed in cases with no prior indication of a high risk of infection.
A prospective randomized study included 269 cesarean sections without a high risk of infection performed in the Maternity and Neonatology Ward of the Sousse Hospital from February 1991 to July 1991. The patients were randomly divided into two groups. One group received an antibiotic prophylactic treatment including cephapirine, gentamicin and metronidazole) and the second group was given no treatment.
Antibiotic prophylactic therapy led to a reduction of infectious morbidity after cesarean section in patients without high risk o infection from 33% to 11%. A 66% rate of efficacy was observed. In addition, antibiotics given in this context led to substantial cost reduction both by reducing the cost of antibiotics prescribed in the postoperative period and by reducing the number of days of hospitalization, and thus total cost.
This study demonstrated the effectiveness of antibiotic prophylaxy for cesarean sections in patients without a high risk of infection. Nevertheless, a reevaluation of the antibiotic protocols and a rigorous operative procedure are essential.
Journal de Gynécologie Obstétrique et Biologie de la Reproduction 02/1994; 23(4):451-5. · 0.42 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Antiphospholipid antibodies are associated with arterial and venous thrombosis and recurrent abortions. However, the prevalence of these antibodies in repeated miscarriages varies in different reports. To obtain quantitative data with restricted criteria and discuss the origin of the variability on the literature, we investigated the presence of antiphospholipid antibodies in 146 women who had 2 or more consecutive pregnancy losses and in 99 women whose pregnancies were successful. Antiphospholipid antibodies (lupus anti-coagulant or anticardiolipin antibodies of 20 or more IgG units) were found in 45% of women with pregnancy losses and in 9% of controls (p < 0.001). The type of loss was determined according to the trimester of pregnancy and the time of the fetal loss. 68% of patients with antiphospholipid antibodies had at least one fetal loss on the second or third trimester compared with 45% of patients without fetal loss (p < 0.01). Further studies should be conducted using more rigorous definition of clinical and laboratory characteristics in a way to allow better comparison between studies.
Annales de biologie clinique 62(2):217-21. · 0.34 Impact Factor
