Outpatient sedation: an essential addition to gynecologic care for persons with mental retardation

Article Abstract:

Routine gynecologic care, including pelvic examinations, are mandated by most states for mentally retarded women, but are often difficult to provide. Poor patient cooperation, concerns about excessive force or coercion, and incomplete examinations often result in insufficient care. A program to provide outpatient sedation as an alternative to general anesthesia during gynecologic examination at a university clinic was begun. To evaluate the safety and effectiveness of ketamine with or without midazolam in this setting, the use of such sedation in 61 retarded women who refused gynecologic examination was evaluated. Fifty-two of 61 patients were successfully examined in 85 of 102 clinic visits. In most patients, one or two doses of sedative were sufficient. Either ketamine or midazolam was given initially, and midazolam was usually given if a second dose was required. All patients with moderate mental handicap were evaluated, while some failed examinations occurred in patients with greater handicaps. No cardiovascular or respiratory complications were noted, and nausea or vomiting were the most common side effects. Nausea decreased in frequency from 38 to 21 percent when the drugs were given in chocolate syrup, but 18 percent still refused medication. The sedation program enhanced the provision of gynecological care to retarded patients and resulted in significant cost savings by avoiding the need for general anesthesia in most cases. Only selective use of this program is advocated. (Consumer Summary produced by Reliance Medical Information, Inc.)

Laws, regulations and rules, Medical examination, Demographic aspects, Dosage and administration, Mentally disabled persons, Ambulatory medical care, Ambulatory care, Gynecologic examination, Anesthetics

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The significance of transvaginal ultrasonographic evaluation of the cervix in women treated with emergency cerclage

Article Abstract:

Cervical and uterine measurements taken from ultrasound images before and after emergency cerclage appear to be useful in predicting pregnancy length. Cerclage is the reinforcement of a weak cervix with stitches. Twenty-nine women requiring emergency cerclage had ultrasound scans of the cervix and lower funnel portion of the uterus before and within two days after cerclage and periodically thereafter until 28 weeks of pregnancy. Women who had upper cervical lengths of less than 10 millimeters were more likely to deliver before 36 weeks. Cerclage significantly improved the cervical and uterine measurements.

Evaluation, Cervix uteri, Incompetent cervix, Operative ultrasound, Operative ultrasonography

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