Althesin in cesarean section

The indications for the employment of Althesin in caesarean section are explained and a substantially favourable opinion is expressed on its clinical effects. Absence of neonatal depression is attributed both to the distribution and metabolism of the drug, and to the features of foetal circulation at term.     

Consumer expectations concerning the quality of food from animals

Quality is the most important feature that a consumer expects from food. There is no objective concept for quality, but "quality" exists in the individual consumers opinion. The quality of a product is, from the consumers point of view, not just its characteristic, but the subjective feeling of each consumer. Empirical examinations show the existence of different "consumer-categories", where the criteria of quality differ elementary. Additional to this subjective opinion the discussion in the media about substances in food that may be harmful to ones health confuses the consumer and leads to a semantic separation between the terms "Eating" and "Nutrition". Especially meat-products are effected by this discussion. The recent increase of a consumers uncertainty concerning meat-products, which is influenced by information and reports about bad conditions in livestock breeding and animal transports as well as conditions in slaughterhouses is reflected. The consumers confrontation with the origin of meat-products causes feelings of guilt and therefore a decreasing request for meat. Although, there is no long term change in eating habits for the majority of the population because of the aspects mentioned before, it must be worked towards an improvement concerning this particular situation as soon as possible.     

Repeated cesarean section

Pregnancies after repeated cesarean sections are often considered to carry high maternal and fetal risks. The pregnancy course, intraoperative and postoperative complications and conditions of newborns were compared between 53 patients who had two or more previous cesarean sections and 58 women sectioned for the second time. No statistical difference was found between the two groups except for intraoperative complications.     

Antibiotic prophylaxis in cesarean section

BACKGROUND: To investigate the guidelines for patient selection and drug regimens for application of antibiotic prophylaxis in relation to cesarean section in the maternity clinics in Denmark. METHODS: A questionnaire to all the Danish maternity clinics that perform cesarean section, concerning indications for application of antibiotic prophylaxis and antibiotic regimens to patients undergoing acute and elective cesarean section. RESULTS: All departments (n = 48) returned the questionnaire. Twenty departments (46%) provided written guidelines for antibiotic prophylaxis. Four departments (8%) used antibiotic prophylaxis to elective cesarean sections, 25 departments (52%) applied antibiotics to all emergency sections. In the presence of the rupture of membranes or prolongation of labor (> 12 hrs) 58% and 63% of the departments applied antibiotic prophylaxis, respectively. The most infrequent first choice drug was cefuroxim, employed by 27 departments (56%). Concerning timing, 21 departments (44%) applied antibiotics after cord clamping and 13 departments (27%) before incision. CONCLUSION: We propose a nation-wide prospective investigation on the rate of infections associated with cesarean section to set up rational guidelines for antibiotic prophylaxis.     

Infections following cesarean section

Postpartum endomyometritis and abdominal wound infection remain the most common infectious complications following childbirth. New information now suggests that incipient infection of the myometrium explains why patients develop postpartum endometritis despite antibiotic prophylaxis. Clinical predictors of postpartum endometritis continue to suffer from low sensitivity. However, use of a Gram stain of the amniotic fluid may be helpful in identifying a subset of women that may benefit from a therapeutic course of antibiotics initiated immediately after cesarean section. Broad-spectrum antimicrobial therapy is the mainstay of therapy for postpartum endometritis. Two newer extended spectrum cephalosporins, cefotetan and ceftizoxime, appear to be as effective as cefoxitin in the treatment of these infections. Abdominal wound infection is a common cause of antimicrobial failure in patients treated for post-cesarean endomyometritis. The genital mycoplasmas, usually resistant to the penicillins and cephalosporins, are commonly isolated from infected wounds following cesarean section. Wound infection surveillance has been shown to decrease infection incidence rates by providing feedback to the operating surgeon.     

Indications for cesarean section in singleton pregnancies in two Danish counties with different cesarean section rates

After observing spikes in the Doppler signal of cerebral arteries of patients with neurologic symptoms and prosthetic heart valves, we then studied two groups of patients with prosthetic heart valves: seven patients with neurologic symptoms and 65 asymptomatic patients. Using transcranial Doppler sonography of the middle cerebral artery, we found Doppler spikes in six symptomatic and 24 asymptomatic patients with mechanical heart valves. No spikes were found in one symptomatic and 21 asymptomatic patients with biological valves or in 20 asymptomatic patients with mechanical valves. We concluded that gas cavitation during the opening or closure of the valve, producing bubble emboli, is the most probable explanation for these Doppler spikes in patients with mechanical prosthetic heart valves.     

The first cesarean section in Norway

The first reported caesarean section in Norway was performed on 20 August 1843 by a general practitioner, Lars Thalian Backer (1812-84). The operation took place in Lardal, Vestfold County, on a 27 year old woman who had been in labour for six days. The outcome was disastrous; she was delivered of stillborn twins and died 2 1/2 days after the operation. In the 19th century, infection, bleeding and thromboembolic disease made caesarean section a dangerous operation, and only 26 such operations are known in Norway, most of them performed outside hospitals. The first caesarean section in Norway resulting in a living child was performed in 1849, but no mother survived the operation before 1890. We recapitulate the caesarean section of 1843; Dr Backer and his qualifications for operative obstetrics; and the state of instrumental and surgical obstetrics in Norway at that time.     

Prevention with antibiotics in cesarean section

The investigation of 222 patients with caesarean section showed an increasing bacterial invasion of the amniotic fluid, when in the patients preoperative was found: - clear or green colored (meconic) amniotic fluid and intact membranes, - clear amniotic fluid with ruptured membranes and - green-colored (meconic) amniotic fluid and ruptured membranes. In support to some conceptions from the literature a perioperative prophylaxis with antibiotics is recommended in the groups, which are potentially endangered postoperatively.     

Acupuncture analgesia and cesarean section

The application of acupuncture anesthesia in obstetrics is discussed and reviewed. Of 14 patients delivered by cesarean section under acupuncture, 8 (57%) felt no pain, and 6 did not go through the entire procedure without other supplementary anesthesia. The failure and success rates are reviewed. It is suggested that the technique be evaluated further because with acupuncture the fetus and mother are completely protected from the secondary effects of general regional anesthesia.     

Morbidity after cesarean section in obese women

The nucleotide sequences of the ribulose-1,5-bisphosphate carboxylase/oxygenase large subunit gene (rbcL) of Glycyrrhiza glabra, G. uralensis, G. inflata, G. echinata, and G. pallidiflora have been determined to construct the phylogenetic tree. In the phylogenetic tree based on the rbcL sequences, the five Glycyrrhiza species were divided into two groups: the three glycyrrhizin-producing species G. glabra, G. uralensis, and G. inflata; and the two glycyrrhizin-nonproducing species G. echinata and G. pallidiflora. Among the three glycyrrhizin-producing species, only two nucleotide substitutions were observed between the rbcL sequence of G. glabra and G. uralensis, and the sequence of G. uralensis was identical to that of G. inflata, indicating that the three glycyrrhizin-producing species are closely related.     

Complications for the mother in vaginal delivery after a prior cesarean section and in parturients with a planned repeat cesarean section

Over a period of 10 years (1980-1989) in the Clinic of Obstetrics and Gynaecology in Stara Zagora 740 women have delivered children after a previous caesarean operation. On the basis of this material the author has studied the vaginal delivery complications for the mother after a previous caesarean operation and in the cases of a second planned caesarean operation. The alternative and correlational analysis of the clinical data has shown that the complications for the mother in the latter group are 3 times more than those in the former group.     

Vaginal birth after cesarean section in twin gestation

OBJECTIVE: We report a 10-year experience with vaginal birth after cesarean section in women with twins. STUDY DESIGN: Data were gathered from labor and delivery records and maternal and neonatal hospital charts. Women with a vertical uterine scar, a previous uterine rupture, an unrepaired dehiscence, or obstetric contraindications to labor were excluded from a trial of labor. Full-thickness uterine defects requiring intervention were classified as ruptures; all others were classified as dehiscences. RESULTS: Between Jan. 1, 1985, and Dec. 31, 1994, at Los Angeles County/University of Southern California Women's Hospital, 210 women with previous cesarean births were delivered of twins. One hundred eighteen (56%) underwent repeat cesarean delivery without a trial of labor. Ninety-two (44%) undertook a trial of labor with no uterine ruptures and no increase in maternal or perinatal morbidity or mortality. CONCLUSIONS: In women with twins a trial of labor after a previous cesarean section is a safe and effective alternative to routine repeat cesarean delivery.     

Fertility in anovulatory patients after primary cesarean section

We report a successful surgical treatment of an infective thoracic aortic aneurysm ruptured to the left lung. A 63-year-old man who had been suffering from fever and cough showed twice of hemoptysis. Chest CT revealed a descending thoracic aortic aneurysm ruptured to the left lung. A semiemergent operation was performed. At operation, aneurysm of descending thoracic aorta was found adherent to the left lung. Aneurysmectomy with left pneumonectomy was carried out. The postoperative course of the patient was uneventful. Conceivably, in order to avoid massive intraoperative bleeding during division of dense adhesion and postoperative graft infection, concomitant lung resection is necessary.