Scar rupture in labour after previous lower uterine segment caesarean section: the role of uterine activity measurement

Article Abstract:

A cesarean section is a surgical procedure that is used to deliver an infant who cannot be delivered vaginally. The surgery involves making an incision in the mother's abdomen and into the uterus so that the baby can be removed. Following delivery, the uterus begins to heal and a scar forms over the area were the incision was made. Over the last several decades, the number of babies delivered by cesarean section has increased dramatically. In the past, women who underwent cesarean sections were recommended to have all subsequent babies delivered by cesarean section as well. This was recommended because it was thought that the contractions of the uterus that occur during a normal labor during vaginal delivery would cause the scar on the uterus to rupture. Symptoms of scar rupture include abnormal fetal heart rate, vaginal bleeding, and pain. In recent years, several studies have shown that women who undergo a cesarean section can subsequently have a normal labor by vaginal delivery, and that rupture of the scar in the uterus is not a common occurrence. It has been suggested that close monitoring of changes in pressure within the uterus during labor (uterine activity) may be useful in protecting against rupture of the scar. Of the women examined, vaginal delivery was achieved without scar rupture in 65 percent. However, out of 10 cases of uterine scar rupture that were examined in detail, six scar ruptures occurred even though uterine activity was within the normal range. It is concluded that measuring changes in pressure within the uterus during labor does not safeguard against scar rupture. (Consumer Summary produced by Reliance Medical Information, Inc.)

Injuries, Risk factors, Cesarean section, Labor, Complicated, Labor complications, Uterus, Pregnant, Pregnant uterus

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Management of retained placenta by umbilical vein injection

Article Abstract:

A very serious complication of childbirth is retained placenta in which the placenta does not separate from the inside wall of the uterus after an infant is born. Untreated, retained placenta can cause death from uncontrolled bleeding or infection. The conventional method of removing a retained placenta is 'manual removal' (by hand). This procedure is performed under anesthesia and can, itself, lead to serious consequences. The author describes a different approach which does not require manual methods and would eliminate the need for transportation to a specialized facility after delivery. The method relies on the injection of saline (a salt solution) into the umbilical vein, which carries blood within the umbilical cord from the placenta to the fetus during pregnancy. A smaller volume of saline can be used if the hormone oxytocin is given simultaneously; oxytocin causes uterine contractions, and enhances separation of the placenta. A review of the literature concerning the effectiveness of this method is presented. Placentas that remain in place for 15 to 30 minutes after delivery are generally considered 'retained'. Studies have found no apparent adverse effects of umbilical injection of oxytocin. However, manual removal of the placenta may become more difficult after the oxytocin injection. Although the injection of oxytocin into the umbilical vein appears to be a promising method for treating retained placenta, certain aspects of the procedure, such as the effect of the injection of fluid versus specific physiologic actions of the hormone, require further investigation. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Placenta, Oxytocin, Injections, Saline, Saline injections

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Diplopia after labour. Case report

Article Abstract:

Acute orbital hemorrhage (bleeding in the eye) can be caused by an increase in pressure within the head, such as when a person tries to exhale forcefully with their nose and mouth closed. There have been previous reports of women developing orbital hemorrhage while giving birth. Women who are in good physical condition, athletes in particular, are capable of generating greater abdominal pressure during labor, and may be at risk for orbital hemorrhage. This article describes the case report of a healthy 33-year-old pregnant woman who developed orbital hemorrhage and double vision (diplopia) after giving birth. The period of labor requiring active pushing lasted 20 minutes. Immediately after giving birth she had double vision and eye pain. Twelve hours later, an eye examination was performed and the patient had 20/20 vision in each eye. The pupils gave a normal response to light, and there was no redness in the eye. Ultrasound imaging revealed a hematoma (a mass of clotted blood). Within 18 days, the double vision disappeared and a second ultrasound confirmed that the hematoma disappeared as well. This case illustrates the importance of ultrasound as method for diagnosing and monitoring orbital hematoma. Ultrasound is safe, specific, accurate, and has several advantages over computed tomography for this type of case. (Consumer Summary produced by Reliance Medical Information, Inc.)

Case studies, Abnormalities, Diagnosis, Causes of, Hemorrhage, Eye, Pregnancy, Complications of, Pregnancy complications, Eye abnormalities, Diplopia

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