A vesicovaginal fistula and intravesical foreign body

Article Abstract:

A pessary is a device inserted into the vagina to structurally support the uterus. Such a device was used in an 82-year-old woman to correct a cystocele, which is a hernia of the bladder that protrudes into the vagina. Twenty-nine months after the insertion of the pessary (during which time she did not see a physician), the patient complained of constant urinary leakage over a six-week period. Examination of the pelvis revealed the presence of urine flowing in the vagina and the displacement of the pessary from the vagina to the bladder. The wall between the vagina and the bladder had eroded, and the pessary had moved completely from the vagina into the bladder. The pessary was removed from the bladder, and the vesicovaginal fistula, or opening between the vagina and bladder, was closed and repaired. Within a month of the operation, the bladder had resumed normal function and the vagina had healed. A pessary may be used to treat prolapse or collapse of genital organs in elderly persons, or in patients who cannot or refuse to undergo surgical repair of genital prolapse. However, a misused or neglected pessary can lead to complications such as severe ulcer formation in the vagina or development of vesicovaginal fistulas, as in this case. Patients, family members, and medical staff should be aware of the need for routine examinations to remove the pessary and cleanse and examine the vagina for injury. However, elderly patients may be forgetful and are often separated from their families, and the implanted pessary may become neglected. Immediate repair of the vesicovaginal fistula prevents the worsening of the lesion. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Causes of, Vagina, Bladder, Pessaries, Fistula, Vesico-vaginal, Vesicovaginal fistula

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Usefulness of continuous fetal heart rate monitoring during cesarean section

Article Abstract:

Fetal distress accounts for 13.2 percent of all cesarean sections (removal of the fetus by abdominal incision). Traditionally, prior to and during the operation, measurement of the fetal heart rate is discontinued and fetal status remains temporarily unknown. However, in two cases of cesarean section, continuous fetal heart monitoring altered the management of the operation. In one delivery, continuous fetal monitoring revealed a declining heart rate, which impelled the surgeon to deliver the fetus faster. In another case, monitoring the fetal heart rate indicated that the fetus was stable, thus preventing potential complications due to rushed surgery. Continuous fetal heart monitoring is therefore useful in improving fetal and maternal outcomes.

Methods, Case studies, Measurement, Fetal distress, Fetal heart rate monitoring, Electronic fetal monitoring, Cesarean section, Labor, Complicated, Labor complications

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Cephalhematoma and caput succedaneum: do they always occur in labor?

Article Abstract:

Cases of cephalhematoma and caput succedaneum may be present prior to birth. Researchers found evidence of hemorrhage and edema in the ultrasound images of seven infants before delivery. This finding stands in contrast to the belief that cephalhematoma is an injury caused during labor and delivery. One additional factor in the context of cephalhematoma may be the premature rupture of membranes, which occurred in five of the seven cases.

Ultrasound imaging, Hematoma, Edema

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