Ectopic pregancy and previous induced abortions: To assess the risk of ectopic pregnancy (EP) by previous induced abortions (IA), a case control study was conducted at Tudu Obstetric and Gynecology hospital in 2000 with 160 cases of extrauterine pregnancy and 320 cases of intrauterine pregnancy under 14 weeks. The results showed that previous induced abortion was the risk of EP with odds ratio (OR) of 4.8(95% Cl: 3.2-7.2). However, we did not find any association between the number of abortions and IA with complications has had the relationship with EP. We found a 24,5 fold increases risk of EP after IA taken place in private sector or commune levels compared with IA taken in hospital or districts hospitals. Uterine curettage was the risk of EP, safe abortion and IA by no invasive procedures should be paid more attention
Pregnancy, Ectopic ; Abortion, Eugenic ; Hysteroscopy ; Abortion, Induced

The study was carried out at Hung Vuong Hospital in 1998 to compare vaginal misoprostol with extra-amniotic balloon to induce abortion in second trimester. Patients were received either 800mcg misoprostol vaginally (n=87) or 500ml of 0.9% NaCl solution inserted into extra-amniotic cavity (n= 93) for induced abortion. Vaginal misoprostol was repeated 24-hourly for maximum of three times. The abortion rates were 98.9% and 96.8% for misoprostol and balloon group, respectively. A second attempt was need in approximate one third of patients in misoprostol group and 10% in balloon group. Side effects of misoprostol were mild and transient. Vaginal misoprostol is as effective as balloon for induced abortion in second trimester. Misoprostol is cheap and easily stored and used. Vaginal misoprostol could be considered as an alternative to balloon for induced abortion
Abortion, Therapeutic ; Misoprostol ; Abortion, Induced

OBJECTIVE: To evaluate the clinical applicability and safety of absorbable synthetic suture materials (Safil(R)/Safil(R)Quick/Monosyn(R)) in obstetrical surgeries. METHODS: This clinical trial includes 100 patients who delivered vaginally and 198 patients who were undergone cesarean section from April 2004 to September 2004. In cases of vaginal delivery, patients were divided with the same number into the study group in which Safil(R) Quick was used and the control group in which chromic catgut was used for episiotomy and perineal laceration repair. In case of cesarean delivery, patients were divided into two groups. The first group which included 100 patients was subdivided with the same number into the study group in which Monosyn(R) was used and the control group in which chromic catgut was used for uterine repair. The second group which included 98 patients was subdivided with the same number into the study group in which Safil(R) was used and the control group in which Vicryl was used for rectus fascia repair. Wound healing status and complications are assessed during postoperative stage, at hospital discharge, and at postpartum out-patients follow-up. RESULTS: Compared with chromic catgut groups, Safil(R) Quick group showed no difference in hospital stay from vaginal delivery, wound healing status and surgical complications and Monosyn(R) group showed no difference in operating time, decrease in hemoglobin at postoperative day 3 and surgical complications. Safil(R) group showed no difference in operating time, postoperative pain and surgical complications compared with Vicryl group. CONCLUSION: Safil(R)/Safil(R) Quick/Monosyn(R) were equivalent with regard to most aspects of their clinical suitability and may be useful alternative suture materials in obstetrical surgeries.
Catgut ; Cesarean Section ; Episiotomy ; Fascia ; Female ; Follow-Up Studies ; Humans ; Lacerations ; Length of Stay ; Obstetric Surgical Procedures* ; Outpatients ; Pain, Postoperative ; Polyglactin 910 ; Postpartum Period ; Pregnancy ; Sutures* ; Wound Healing

Since 1980, there have been 5 patients had lesions such as rag, cut-off, partial loss or legation. It should examine the vagina for finding the fistula, fibrosis, ulceration, malignant tumor if there was urine in the vagina. The management depended on the lesions and time when the lesions were detected
complications ; Obstetric Surgical Procedures ; surgery

The use of intraspinal narcotics has attracted great interest, particularly in the discipline of obstetric anesthesia. As the advent of spinal and epidural local anesthetics dramatically effected the anesthetic management of labor, delivery and obstetric surgery, likewise intraspinal narcotics are emerging as safe and very effective methods of relieving post cesarean section pain, improving labor and cesarean section analgesia in combination with local anesthetics, and injected alone in the subarachnoid space for the management of labor itself. Though intraspinal narcotic analgesia is associated with a number of specific side effects, with proper management these adverse reactions are either avoidable or can be greatly minimized. Compared to the benefits of nearly complete pain relief in the intrapartum and postpartum periods, the price paid in terms of these side effects is minimal. Few mothers, who have undergone cesarean section both with and without postpartum epidural narcotics, would give up the excellent analgesia afforded to avoid the side effects associated with their use. Excellent reviews of the development and clinical application of intraspinal narcotics have been made by Yaksh, Cousins, Elkins-Sinn and Hughes.
Analgesia ; Anesthesia, Obstetrical ; Anesthetics, Local ; Cesarean Section ; Female ; Humans ; Mothers ; Narcotics* ; Obstetric Surgical Procedures ; Obstetrics* ; Postpartum Period ; Pregnancy ; Subarachnoid Space

Cesarean section is the most commonly performed obstetrical surgical procedure; however, there are no standard guidelines on appropriate skin closure techniques and materials. Only few comparative studies have been conducted on different skin closure techniques, and they have shown conflicting results. Therefore, we compared different skin closure techniques during emergency cesarean section to identify the best technique with minimal wound complication rates.METHODS: Patients were randomized into 3 groups (group A, n=100; group B, n=102; and group C, n=98). In group A, the skin was closed using staples; in group B, via the subcuticular technique using monocryl 3-0; and in group C, using mattress suture nylon (2-0). The primary outcome was a composite of wound complications, including infection, seroma, gaping, and need for resuturing and antibiotic administration. The secondary outcome included closure time, pain perception, patient satisfaction, and cost. Analyses were performed in accordance with the intention-to-treat principle.RESULTS: The composite wound complication rate in the entire cohort was 16.6% (n=50); the complication rate was significantly higher in group A than in the other groups. Infection was the most common wound complication observed in the entire study group (86%) and was significantly higher in group A than in groups B and C (P≤0.001).CONCLUSION: The use of staples for cesarean section skin closure is associated with an increased risk of wound complications and prolonged hospital stay postoperative visits.]]>
Cesarean Section ; Cohort Studies ; Emergencies ; Female ; Humans ; Length of Stay ; Nylons ; Obstetric Surgical Procedures ; Pain Perception ; Patient Satisfaction ; Pregnancy ; Seroma ; Skin ; Sutures ; Wounds and Injuries

Background: Surgical site infection (SSI) is a common complication among all surgical cases. It is the most common nosocomial infection identified in the developing world with pooled incidence of 11.8 per 100 surgical procedures. In our institution, the SSI rate in major obstetric and gynecologic cases in years 2000–2013 is 12.68%. Objective: To compare the efficacy of a single-dose cefazolin versus a single dose cefazolin plus 7-day mupirocin ointment wound application in preventing SSI among women undergoing major obstetric and gynecologic abdominal surgical procedures. Materials and Methods: The study included are 164 female participants, aged 18–65 years old who underwent major obstetric and gynecologic surgical procedures. Participants were randomly assigned to Groups A and B, wherein all participants were given single dose of 2 g cefazolin, intravenous, 30 min before skin incision. For the participants in Group B, an additional 7-day application of mupirocin ointment on incisional wound during the postoperative period was given. Assessment for occurrence of SSI and healing time using a standardized collection tool and Southampton wound scoring system, respectively, was done on the 8th, 15th, and 30th postoperative days. Results: The incidence of SSI is 2.45% (4 out of 164 participants). It was slightly higher in the Cefazolin only arm having three cases, while only one case in the Cefazolin plus mupirocin group. However, the difference of SSI occurrence between the two groups is not statistically significant. Wound healing time was also evaluated which was comparable between treatment groups. Conclusion Single dose Cefazolin plus 7-day once daily Mupirocin ointment application is comparable to single dose of cefazolin in preventing SSI in patients undergoing major low-risk obstetric and gynecologic surgeries. Therefore, the addition of mupirocin in uncomplicated major obstetric and gynecologic surgical cases is not cost-beneficial.
Cefazolin ; Gynecologic Surgical Procedures ; Mupirocin ; Obstetric Surgical Procedures ; Surgical Wound Infection

PURPOSE: Injuries to the urinary tract are most likely to result from pelvic surgery. Injuries might lead to intense morbidity and mortality unless treated promptly. This review discusses the causes, diagnosis and management of injuries to the urinary tract result from obstetric and gynecologic surgery. MATERIALS AND METHODS: Seventy six patients with iatrogenic injuries to the urinary tract that occurred during obstetric and gynecologic surgeries, between 1986 and 2003, were enrolled in the study. RESULTS: Fifty bladder injuries, 19 ureter injuries, 5 vesicovaginal fistulae and 2 ureterovaginal fistulae are presented. The ureteral injuries included: 11 transections (52.4%), 8 ligations (38.1%) and 2 ureterovaginal fistulae (9.5%). The initial operations complicated by urologic injuries were: TAH in 39 patients (51.3%)., cesarean sections in 17 (22.4%), bladder injuries in 49 and transected ureteral injuries in 11, which were promptly diagnosed and primarily repaired. However, 8 ureteral ligations, 2 ureterovaginal fistulae and 5 vesicovaginal fistulae had delayed diagnoses. In these cases, ureteral stenting and a nephrostomy can be used as the first approach to controlling the injury. A double-J catheter insertion only was performed in 2 cases, ureteral balloon dilatation 3 and open repair in the others. CONCLUSIONS: Bladder injuries, more than ureter injuriesy, are caused by obstetric and gynecologic surgeries. However, the morbidity with ureter injuries is more severe than that of bladder injuries. The early diagnosis and urological intervention are important for the effectiveness of the treatment. Also, endourologic management is recommended for a ligated ureter.
Catheters ; Cesarean Section ; Delayed Diagnosis ; Diagnosis ; Dilatation ; Early Diagnosis ; Female ; Fistula ; Gynecologic Surgical Procedures* ; Humans ; Ligation ; Mortality ; Obstetric Surgical Procedures ; Pregnancy ; Stents ; Ureter ; Urinary Bladder ; Urinary Tract* ; Vesicovaginal Fistula

BACKGROUNDThe rate of cesarean delivery has significantly increased in China in the last decade. Women with prior cesarean history tend to have a higher risk of uterine rupture during termination of the pregnancy in mid-trimester than those without such a history. The aim of our study was to evaluate the influences of the potential risk factors on uterine rupture in women with prior cesarean.

METHODSWe conducted this retrospective study of women with prior cesarean section, who underwent mid-trimester pregnancy termination between January 2006 and December 2013 in Peking Union Medical College Hospital. The protocol was oral administration of mifepristone and misoprostol for the patients with the gestational ages below 16 weeks or intra-amniotic injection of ethacridine lactate (EL) for those with at least 16 weeks of gestational ages. The thickness of the lower uterine segment (LUS) was measured before the termination of pregnancy. Logistic regression was used to study the risk factors of uterine rupture.

RESULTSThe total rate of successful abortion was 93.9% (62/66). Four patients failed in induction, and one of them received curettage, whereas the other three experienced uterine rupture (4.5%). The successful rates of abortion were 85.7% (30/35) for women treated with mifepristone-misoprostol and 86.1% (31/36) for those treated with EL. There was a significant difference in the mean LUS thickness between the uterine rupture group (3.0 ± 2.0 mm) and the nonrupture group (7.0 ± 3.0 mm) (P < 0.05). The LUS thickness of <3 mm was associated with uterine rupture during mid-trimester pregnancy termination in women with prior cesarean (odds ratio, 94.0; 95% confidence interval 4.2-2106.1) after adjusted maternal age, gestational age, interdelivery interval and prior cesarean section. Severe bleeding that required transfusion occurred in one case (1.5%).

CONCLUSIONSBoth the mifepristone-misoprostol and the EL regimens were effective and safe for the termination of mid-trimester pregnancy in women with prior cesarean. A thinner LUS is associated with a relatively high risk of uterine rupture.

Abortion, Induced ; adverse effects ; methods ; Cesarean Section ; Ethacridine ; therapeutic use ; Female ; Humans ; Mifepristone ; therapeutic use ; Misoprostol ; therapeutic use ; Pregnancy ; Pregnancy Trimesters ; Retrospective Studies ; Uterine Rupture ; etiology

*Anesthesia, Obstetrical ; *Episiotomy ; *Extraction, Obstetrical ; *Pregnancy Complications ; *Infant, Newborn ; *Pregnancy