1,721,327 research outputs found
Postpartum hemorrhage and emergency hysterectomy in a patient with mitochondrial myopathy: a case report.
No full textArch Gynecol Obstet. 2003 Feb;267(4):247-9. Epub 2002 Sep 26.
Postpartum hemorrhage and emergency hysterectomy in a patient with mitochondrial myopathy: a case report.
Dessole S, Capobianco G, Ambrosini G, Battista Nardelli G.
SourceDepartment of Pharmacology, Gynecology and Obstetrics, 07100 Viale San Pietro 12, Sassari, Italy. [email protected]
Abstract
Mitochondrial myopathies are a rare biochemical group of disorders of the mitochondrial respiratory chain. We report the first case in the literature of a pregnant woman with mitochondrial myopathy who, after cesarean section, had a severe and massive postpartum hemorrhage that required emergency supracervical hysterectomy. We discuss the case and review the literature
CESAREAN SECTION: PAST, PRESENT AND FUTURE
No full textCaesarean section is a surgical procedure of ancient origins: it was performed to extract the baby after the woman had died. Today, cesarean section is necessary when vaginal birth is not possible or poses the mother or the child at high risk. In the last thirty years, this procedure has been increasingly used, particularly in Western countries, with values ranging from 14% in the Scandinavian countries to 30-35% in the USA and approximately 38% of deliveries in Italy. The increase in delivery by caesarean section is due to several factors: the progress of anesthetic techniques and surgical procedures, advanced maternal age of first delivery (32 years in the third millennium), growing medical litigation and the consequent use of defensive medicine [1-3]. Furthermore, other causes include the organization of hospitals, with the Healthcare system paying higher refunds for caesarean sections compared to natural deliveries, and the right of women to avoid pain and give birth “on request” by caesarean section. In this study we analyzed the characteristics of all patients who underwent caesarean section at the Maternal University Hospital in Sassari in 2014. This hospital is a third-level of high specialization, attracting pregnant patients from central and northern areas of Sardinia. Mothers who had a caesarean section were older and had on average a higher education level (over 78% had a high school degree, a bachelor’s or master’s degree) compared to women who gave birth by vaginal delivery. Moreover, they often lived in towns of Central and Northern Sardinia referring to hospitals without a neonatal intensive care unit, and they were then admitted to our Clinic for severe diseases of prematurity needing a fast and safe delivery, namely caesarean section. In the future, particularly in industrialized countries, it will be possible to contain the prevalence of cesarean section within the current percentage (38%), but it will probably not be reduced. In fact, several factors related to global social and cultural changes will be likely to play a role, such as a very low birth rate (around 1 child per couple), an average older age of first pregnancy (related to high levels of education and career), and a greater degree of self-determination in choosing the mode of delivery compared to the past. In the present circumstances, caesarean section should not be demonized, as with its low anesthetic and surgical risk it guarantees a safe childbirth for both mother and child.
REFERENCES
[1] Capobianco G, Balata A, Mannazzu MC, Oggiano R, Pinna Nossai L, Cherchi PL, Dessole S. Perimortem cesarean delivery 30 minutes after a laboring patient jumped from a fourth-floor window: baby survives and is normal at age 4 years. Am J Obstet Gynecol. 2008;198(1):e15-6.
[2] Capobianco G, Angioni S, Dessole M, Cherchi PL. Cesarean section: to be or not to be, is this the question? Arch Gynecol Obstet. 2013;288(2):
461-2.
[3] Dessole S, Cosmi E, Balata A, Uras L, Caserta D, Capobianco G, Ambrosini G. Accidental fetal lacerations during cesarean delivery: experience in an Italian level III university hospital. Am J Obstet Gynecol. 2004;191(5):1673-7
Determining the best catheter for sonohysterography
No full textFertil Steril. 2001 Sep;76(3):605-9.
Determining the best catheter for sonohysterography.
Dessole S, Farina M, Capobianco G, Nardelli GB, Ambrosini G, Meloni GB.
SourceDepartment of Pharmacology, University of Sassari, University of Sassari, Sassari, Italy. [email protected]
Abstract
OBJECTIVE: To compare the characteristics of six different catheters for performing sonohysterography (SHG) to identify those that offer the best compromise between reliability, tolerability, and cost.
DESIGN: Prospective study.
SETTING: University hospital.
PATIENT(S): Six hundred ten women undergoing SHG.
INTERVENTION(S): We performed SHG with six different types of catheters: Foleycath (Wembley Rubber Products, Sepang, Malaysia), Hysca Hysterosalpingography Catheter (GTA International Medical Devices S.A., La Caleta D.N., Dominican Republic), H/S Catheter Set (Ackrad Laboratories, Cranford, NJ), PBN Balloon Hystero-Salpingography Catheter (PBN Medicals, Stenloese, Denmark), ZUI-2.0 Catheter (Zinnanti Uterine Injection; BEI Medical System International, Gembloux, Belgium), and Goldstein Catheter (Cook, Spencer, IN).
MAIN OUTCOME MEASURE(S): We assessed the reliability, the physician's ease of use, the time requested for the insertion of the catheter, the volume of contrast medium used, the tolerability for the patients, and the cost of the catheters.
RESULT(S): In 568 (93%) correctly performed procedures, no statistically significant differences were found among the catheters. The Foleycath was the most difficult for the physician to use and required significantly more time to position correctly. The Goldstein catheter was the best tolerated by the patients. The Foleycath was the cheapest whereas the PBN Balloon was the most expensive.
CONCLUSION(S): The choice of the catheter must be targeted to achieving a good balance between tolerability for the patients, efficacy, cost, and the personal preference of the operator
Ultrasound-guided mammotome vacuum biopsy for the diagnosis of impalpable breast lesions
No full textUltrasound Obstet Gynecol. 2001 Nov;18(5):520-4.
Ultrasound-guided mammotome vacuum biopsy for the diagnosis of impalpable breast lesions.
Meloni GB, Dessole S, Becchere MP, Soro D, Capobianco G, Ambrosini G, Nardelli GB, Canalis GC.
SourceInstitute of Radiology, Italy.
Abstract
OBJECTIVES: To assess the diagnostic accuracy of ultrasound-guided mammotome vacuum biopsy in impalpable breast lesions.
METHODS: Seventy-three patients who presented with impalpable breast lesions that were suspicious for malignancy at mammography and/or sonography were included in the study. In the first instance the women underwent ultrasound-guided fine-needle aspiration cytology, then, 3 days later, histological biopsy with an ultrasound-guided mammotome device. The patients with both cytological and histological diagnoses of malignancy underwent surgery; those with a negative (for malignancy) cytological diagnosis, but with a histological diagnosis of atypical hyperplasia or sclerosing adenosis, underwent surgical biopsy.
RESULTS: The diagnostic accuracy of fine-needle aspiration cytology was 67.2%; the sensitivity was 86.7%, the specificity was 48.4%, the negative predictive value was 78.9% and the positive predictive value was 61.9%. In comparison, the diagnostic accuracy of histological sampling by mammotome vacuum biopsy was 97.3%; the sensitivity was 94.7%, the specificity was 100%, the negative predictive value was 94.6% and the positive predictive value was 100%. Thus there was a statistically significant difference in diagnostic accuracy between fine-needle aspiration cytology and mammotome vacuum biopsy (67.2% vs. 97.3%; chi2 test, P < 0.001). The 2.7% (2/73) failure rate of mammotome biopsy was likely to be due to an error in the positioning of the needle. The subsequent surgical biopsy proved that two cases, negative for malignancy by mammotome biopsy, were in fact malignant.
CONCLUSIONS: Our data confirm the value of sonography for the diagnosis of breast carcinoma in the preclinical phase and the efficacy of ultrasound sampling using a mammotome device to confirm the diagnosis in impalpable breast lesions
Transvaginal sonohysterography for the assessment of postpartum residual trophoblastic tissue: is a safe procedure?
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