Background: Pregnant women that are complaining from paraumbilical hernia postpone its repair until they get birth. We hypothesized that it will be better to perform hernia repair of such type of hernia simultaneously...Background: Pregnant women that are complaining from paraumbilical hernia postpone its repair until they get birth. We hypothesized that it will be better to perform hernia repair of such type of hernia simultaneously during performing cesarean section (CS) which will help to decrease future morbidity re-operation, avoid complications and further skin incision. In this study we aimed to compare the value of performing para-umbilical hernia repair simultaneously during performing CS through the same skin incision with performing para-umbilical hernia repair simultaneously during performing CS through another infra- or supra-umbilical skin incision and performing para-umbilical hernia repair electively later on after healing of a CS skin incision in relation to clinical recovery and patient satisfaction. Patients and Methods: This is a prospective cohort study, where we included 45 pregnant female patients who will give birth by CS, and we have divided them into 3 groups: the first group of patients (A) included 15 patients that undergoing paraumbilical hernia repair by pre-peritoneal mesh insertion through CS incision, the second group of patients (B) in-cluded 15 patients that undergoing paraumbilical hernia repair by infra- or supra-umbilical incision during CS incision and the third group of patients (C) included 15 patients that undergoing paraumbilical hernia repair by infra- or supra-umbilical incision later on after healing of the CS wound. We have evaluated advantages of that novel approach e.g. operation time, severity of pain, peri-partum and post-operative complications, financial cost, duration of hospital stay, clinical recovery, mesh rejection, and patient satisfaction. Results: In group A there is shorter duration of hospital stay, no new skin incision (p 0.002). Conclusions: Performing para-umbilical hernia repair by insertion of a pre-peritoneal mesh simultaneously during performing CS through the same skin incision is the best method of management of para-umbilical hernia in pregnant woman.展开更多
<strong>Objective:</strong><span><span style="font-family:Verdana;"> Misoprostol vaginal insert (MVI) is proven to induce labor by a </span><span style="font-family:Verd...<strong>Objective:</strong><span><span style="font-family:Verdana;"> Misoprostol vaginal insert (MVI) is proven to induce labor by a </span><span style="font-family:Verdana;">continuously release of PGE1. Previous reports showed that MVI reduced</span><span style="font-family:Verdana;"> induction to delivery time as well as active labor time but it also increased uterine tachysystole. Here we attempted to clarify whether MVI is safe and </span><span style="font-family:Verdana;">efficient for women with pregnancies >40 weeks in a single institute.</span> <b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This study was performed in Lutheran Hospital Bergisch Gladbach, Germany 2014-2019. A total of 304 women between 40 + 0 to 42 + 0 weeks underwent labor induction with MVI. Outcomes were</span></span><span style="font-family:Verdana;">:</span><span><span style="font-family:Verdana;"> 1) maternal: time from insertion </span><span style="font-family:Verdana;">to delivery, interventions, mode of delivery, and uterine tachysystole, 2)</span><span style="font-family:Verdana;"> neo</span></span><span style="font-family:Verdana;">-</span><span><span style="font-family:Verdana;">natal: cord blood pH, APGAR scores, and admission to a neonatal clinic. This </span><span style="font-family:Verdana;">study ended unexpectedly due to the withdrawal of MVI (Misodel<span style="white-space:nowrap;"><sup>TM</sup></span>) in</span><span style="font-family:Verdana;"> September 2019. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">75.7% (n = 230) of women gave birth within 24 hours after MVI placement. 72.2% (n = 140) nulliparous women and 81.8% (n = 90) </span><span style="font-family:Verdana;">parous women delivered within 24 hours. In two cases emergency CS was</span><span style="font-family:Verdana;"> required. 67.8% (n = 206) of women delivered vaginal. 2.3% (n = 7) of cord pH levels were below 7.10. 3.3% (n = 10) of newborns were transmitted to a neonatal clinic. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">MVI is an efficient method to induce labor for </span><span style="font-family:Verdana;">pregnant women beyond 40 + 0 weeks. However, considering various</span><span style="font-family:Verdana;"> compli</span><span style="font-family:Verdana;">cations observed (uterine tachysystole and fetal distress leading to a high</span><span style="font-family:Verdana;"> number of CS), we cannot universally advocate the use of MVI.</span></span>展开更多
文摘Background: Pregnant women that are complaining from paraumbilical hernia postpone its repair until they get birth. We hypothesized that it will be better to perform hernia repair of such type of hernia simultaneously during performing cesarean section (CS) which will help to decrease future morbidity re-operation, avoid complications and further skin incision. In this study we aimed to compare the value of performing para-umbilical hernia repair simultaneously during performing CS through the same skin incision with performing para-umbilical hernia repair simultaneously during performing CS through another infra- or supra-umbilical skin incision and performing para-umbilical hernia repair electively later on after healing of a CS skin incision in relation to clinical recovery and patient satisfaction. Patients and Methods: This is a prospective cohort study, where we included 45 pregnant female patients who will give birth by CS, and we have divided them into 3 groups: the first group of patients (A) included 15 patients that undergoing paraumbilical hernia repair by pre-peritoneal mesh insertion through CS incision, the second group of patients (B) in-cluded 15 patients that undergoing paraumbilical hernia repair by infra- or supra-umbilical incision during CS incision and the third group of patients (C) included 15 patients that undergoing paraumbilical hernia repair by infra- or supra-umbilical incision later on after healing of the CS wound. We have evaluated advantages of that novel approach e.g. operation time, severity of pain, peri-partum and post-operative complications, financial cost, duration of hospital stay, clinical recovery, mesh rejection, and patient satisfaction. Results: In group A there is shorter duration of hospital stay, no new skin incision (p 0.002). Conclusions: Performing para-umbilical hernia repair by insertion of a pre-peritoneal mesh simultaneously during performing CS through the same skin incision is the best method of management of para-umbilical hernia in pregnant woman.
文摘<strong>Objective:</strong><span><span style="font-family:Verdana;"> Misoprostol vaginal insert (MVI) is proven to induce labor by a </span><span style="font-family:Verdana;">continuously release of PGE1. Previous reports showed that MVI reduced</span><span style="font-family:Verdana;"> induction to delivery time as well as active labor time but it also increased uterine tachysystole. Here we attempted to clarify whether MVI is safe and </span><span style="font-family:Verdana;">efficient for women with pregnancies >40 weeks in a single institute.</span> <b><span style="font-family:Verdana;">Methods: </span></b><span style="font-family:Verdana;">This study was performed in Lutheran Hospital Bergisch Gladbach, Germany 2014-2019. A total of 304 women between 40 + 0 to 42 + 0 weeks underwent labor induction with MVI. Outcomes were</span></span><span style="font-family:Verdana;">:</span><span><span style="font-family:Verdana;"> 1) maternal: time from insertion </span><span style="font-family:Verdana;">to delivery, interventions, mode of delivery, and uterine tachysystole, 2)</span><span style="font-family:Verdana;"> neo</span></span><span style="font-family:Verdana;">-</span><span><span style="font-family:Verdana;">natal: cord blood pH, APGAR scores, and admission to a neonatal clinic. This </span><span style="font-family:Verdana;">study ended unexpectedly due to the withdrawal of MVI (Misodel<span style="white-space:nowrap;"><sup>TM</sup></span>) in</span><span style="font-family:Verdana;"> September 2019. </span><b><span style="font-family:Verdana;">Results: </span></b><span style="font-family:Verdana;">75.7% (n = 230) of women gave birth within 24 hours after MVI placement. 72.2% (n = 140) nulliparous women and 81.8% (n = 90) </span><span style="font-family:Verdana;">parous women delivered within 24 hours. In two cases emergency CS was</span><span style="font-family:Verdana;"> required. 67.8% (n = 206) of women delivered vaginal. 2.3% (n = 7) of cord pH levels were below 7.10. 3.3% (n = 10) of newborns were transmitted to a neonatal clinic. </span><b><span style="font-family:Verdana;">Conclusion: </span></b><span style="font-family:Verdana;">MVI is an efficient method to induce labor for </span><span style="font-family:Verdana;">pregnant women beyond 40 + 0 weeks. However, considering various</span><span style="font-family:Verdana;"> compli</span><span style="font-family:Verdana;">cations observed (uterine tachysystole and fetal distress leading to a high</span><span style="font-family:Verdana;"> number of CS), we cannot universally advocate the use of MVI.</span></span>