Vasopressin and operative hysteroscopy in the management of delayed postabortion and postpartum bleeding

Article Abstract:

Hemorrhages occurring days or weeks after delivery or abortion are uncommon, and few studies discuss how best to treat this problem. Usually, delayed bleeding is treated by dilation and curettage (D and C). If this is ineffective, packing with gauze or other absorbent material, ligation (tying) of the uterine artery, or hysterectomy may then be done. Two case studies are described in which bleeding that did not respond to conventional treatment was successfully stopped by local application of vasopressin (a hormone that can cause constriction of blood vessels), which then allowed hysteroscopy (visualization) and cauterization of bleeding areas in the uterus. The first patient was 27 years old and began bleeding heavily four days after an uncomplicated pregnancy termination. After transfusions, the entire uterus was given curettage; no tissue was obtained and bleeding was not reduced. With drug treatment and bed rest, bleeding subsided, but then began three days later while the patient was still inactive. After more transfusions, dilute vasopressin was injected around the cervix, and bleeding slowed dramatically. The uterus could then be inspected; clots were cleared, and bleeding and oozing points were coagulated. Gauze soaked in vasopressin was packed in the uterus. The patient was given antibiotics, and no further bleeding occurred; packing was removed. Normal menstruation resumed within eight months since discharge. The second patient was 43 years old and began bleeding 20 days after a cesarean section was performed at 33 weeks of gestation. After transfusions, vasopressin was injected, slowing the previously profuse bleeding. Bleeding points were coagulated and large amounts of placental tissue and membranes were observed and removed. After further coagulation, vasopressin-soaked gauze was inserted and later removed after no further bleeding occurred. Normal menstruation resumed within four months after discharge. These studies illustrate how injection of vasopressin or other vasoconstrictors can allow visualization and treatment without resorting to major surgical procedures in at least some cases of delayed postpartum or postabortion hemorrhage. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Case studies, Drug therapy, Hemorrhage, Abortion, Vasopressin, Vasopressins, Vasoconstrictors, Vasoconstrictor agents, Puerperal disorders

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Funic reduction for the management of umbilical cord prolapse

Article Abstract:

Umbilical cord prolapse, displacement of the umbilical cord to below the fetus during labor, is dangerous because any pressure may stop the flow of blood, which contains oxygen and nutrients, to the fetus. This is currently treating by trying to minimize fetal pressure on the cord while preparing the patient for emergency cesarean section. In the past, before cesarean sections were as routine, funic reduction (manual replacement of the umbilical cord), was considered standard procedure in managing the problem. This was sometimes successful, but other times resulted in newborns who were stillborn or asphyxiated. The 10-year experience of one doctor is described, in which funic reduction was attempted during continuous fetal monitoring. Of 2,188 deliveries, there were eight cases of umbilical cord prolapse. In all cases, newborns were alive and healthy. One patient was given a cesarean section because cervical dilatation was inadequate for funic reduction. As there was no fetal distress, the patient was given epidural anesthetic, rather than general anesthesia, which is common in emergency cases and carries greater complications. Two patients were delivered vaginally without funic reduction, as delivery immediately followed prolapse diagnosis. Funic reduction was successful in all five patients for whom it was attempted. Fetal heart rates typically slowed for three to five minutes with funic reduction, and this was mild or transient in four cases. Prolapse was likely related to medical procedures in two cases. The study suggests that funic reduction may be an appropriate treatment of umbilical cord prolapse when only a short segment has prolapsed, there is no fetal distress, the cervix is dilated over 4 centimeters, the patient is cooperative, and the physician is skilled. Continuous fetal monitoring and simultaneous preparation for emergency cesarean section are essential. (Consumer Summary produced by Reliance Medical Information, Inc.)

Umbilical cord

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Incidence of genital herpes simplex virus at the time of delivery in women with known risk factors

Article Abstract:

Although the incidence (number of new cases) of genital infection with Herpes simplex virus (HSV) is increasing, the management of genital HSV infection in pregnant women at delivery has not been clearly established. The objective of management should be to protect the fetus from contact with HSV during labor and delivery. Hence, cesarean section would be necessary for patients with HSV lesions. However, cesarean section may be warranted in asymptomatic (symptomless) women who have a high risk of genital HSV infection. Shedding of HSV infected tissue can occur without symptoms, causing infection in the fetus. However, one study reported that there was no risk of HSV infection in 34 newborns delivered vaginally to high-risk women. The incidence of genital HSV infection was assessed at delivery in 143 women with a high risk of HSV infection. Culturing, or attempts to grow the virus under laboratory conditions, was used to test for the presence of HSV. Symptoms of genital HSV infection did not develop in 123 women, including 3 with positive HSV cultures at delivery. Lesions that were characteristic of genital HSV infection developed in 15 women; 5 had positive culture results. Prodromal (early) symptoms were detected in five women, and two of these women had positive cultures at the sites of previous lesions. HSV infection was not detected in the infants of 10 women with positive cultures for HSV, including 2 women who had vaginal deliveries. Women with a high risk of genital HSV infection, but without symptoms of the disease, should be given the opportunity to deliver vaginally. However, cesarean section is recommended for women with lesions or prodromal symptoms characteristic of genital HSV infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Cases, Herpes genitalis, Genital herpes, Herpes simplex virus

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