A Case of Pelvic Migraine

A 62-year-old woman presented with an 8-year history of chronic persisting pelvic pain. She described constant throbbing, stabbing vaginal pain. A pelvic floor neurophysiological assessment of the pudendal nerve was performed by performing a needle EMG to the left and right external anal sphincter assessing for insertional activity and recruitment pattern. A quantitative assessment of the motor unit action potentials [MUAPs] was also performed. Tests confirmed a left pudendal neuropathy with chronic denervation in the left external anal sphincter, with reasonable muscle function, with a recruitment pattern of 65% - 70% of normal. The CAR showed an elevated sensory threshold with a normal distal latency. All other conventional pudendal nerve treatments including oral antiepileptic medication, neuromodulation and pudendal nerve blocking injections had failed, and the patient was exacerbated by the persisting pain and discomfort. In this case, 30 international units (iu) of botulinum toxin type A in 10 divided doses of 3 iu were injected along the nerve. Four days later the patient reported a significant improvement in the pain symptoms. She was reviewed 3 weeks later and for the first time in 8 years had made the 70 mile journey to the clinic as a passenger in her husband’s car. This case highlights a new therapeutic option of botulinum toxin type A injection, along the nerve length, for this common painful condition. It seems to have clinical veracity as unlike other therapeutic option the affect lasts for 3 or 4 months.

对有发生髋关节发育不良的高风险儿进行髋部超声扫描筛查

Background: Clinical examination, while useful, has been shown to be insuffici ent as the sole screening method in infants. Ultrasound examination at 8 weeks i n high risk infants is an integral part of the screening process in some units. Aims: To snow the efficiency of hip sonography in detection of developmental dys plasia of the hips in those without clinically dislocated hips. Methods: All inf ants born at the National Maternity Hospital between January 1994 and December 2 001 were included. All those with clinically dislocated hips were treated by a P avlik harness and referred for follow up to a paediatric orthopaedic surgeon. An 8 week hip ultrasound scan was performed for those infants with stable hips on examination but who met the following criteria: (1) a first degree relative with congenital dislocation of hips; (2) breech presentation at birth; and (3) a per sistent “click”at birth in an otherwise stable hip. Results: During the period of study a total of 52 893 infants were born in the National Maternity Hospital . Based on the criteria above, 5485 hip ultrasound scans were performed. Of thos e scanned, 18 (0.33%)were found to have dislocated hips and 153 (2.78%)-to ha ve dysplasic hips. The 18 infants with dislocation were treated with Pavlik harn ess; the remaining 153 were followed up by serial ultrasound examinations but di d not require active intervention. Conclusions: Among the population of infants at increased risk of developmental dysplasia of the hip, the hip screening progr amme identified 18 cases among 5485 infants; a rate of 3.2 per 1000. Hip sonogra phy is therefore worthwhile.

前次剖宫产分娩后阴道分娩和前次阴道分娩后剖宫产分娩产妇的满意度比较

Abstract:Abstract:Objectives: To compare (i) satisfaction levels among women who delivered vaginally after one previous caesarean (VBAC)-with women delivered by caesarean after previous vaginal delivery (CSAVD) and (ii) to assess reasons why women may request caesarean delivery on subsequent pregnancies. Study design: We conducted a prospective questionnaire-based study of maternal satisfaction following both modes of delivery during an 8-month period. Results: One hundred and forty women completed an early postnatal questionnaire, 70 each in VBAC and CSAVD cohorts. The vast majority in both groups were satisfied with their respective mode of delivery, but would opt for vaginal delivery in their next pregnancy (89% in VBAC versus 94% in CSAVD). The VBAC group experienced minimal pain after delivery and had felt better prepared for delivery (74% versus 41% in the CSAVD group). Reasons for dissatisfaction in the VBAC group included the physical stress of labour and inadequacy of analgesia. Conclusion: Maternal satisfaction with vaginal delivery is high. Those who have experienced both modes of delivery would prefer vaginal birth on future pregnancies. These findings are reassuring to women contemplating vaginal delivery.

超声检测结合妊娠早期颈后皮下半透明层厚度筛查诊断胎儿畸形的可行性研究

The purpose of this study was to determine the effectiveness of a fetal anatomy survey in conjunction with first-trimester nuchal translucency (NT) screening ultrasound in an unselected pregnant population performed by sonographers. Study design: This was a prospective observational study of women presenting for NT screening for chromosomal defects. An anatomic survey was performed after a standardized protocol with a maximum scan time of 30 minutes. Results: Three hundred twenty-five singleton fetuses (11+ 0 to 13+ 6 weeks)- were examined and pregnancy outcome was available for 300 (92.3% ) of cases. In 89 (24.6% ) cases, transvaginal ultrasound was performed. The following fetal structures were seen in 95% of cases: cranium and intracranial anatomy, face, cord insertion, stomach, and all 4 limbs. The bladder was visualized in 89.5% of cases, the cardiac 4 chamber view in 84% , and the spine in only 45% of cases. Complete anatomy was seen in 109 (33% ). Crown rump length greater than 55 mm and sonographer experience were important factors contributing to anatomic visibility. Of a total of 6 congenital defects in this cohort, 1 was detected in the first trimester (neural tube defect), 4 at the 18- to 20- week anatomic scan, and 1 postnatally. Conclusion: A complete anatomy survey was successful in 33% of first-trimester fetuses in a time-limited sonographer based screening program. Since some anomalies are not evident in the first trimester, the 18- to 20- week scan remains the gold standard.

足月新生儿窒息后抽搐和围生期死亡率与剖宫产率增加无关

The purpose of this analysis was to study the relationship between an increasing cesarean delivery rate and term neonatal seizures and peripartum deaths. This was a retrospective analysis of annually collated institutional data on cesarean delivery and perinatal outcome. Of 77,350 women who delivered at 37 weeks’ gestation or more through 12 years (1989 to 2000), the cesarean rate increased from 6.9% to 15.1% ; perinatal mortality at term, average 3.1/1000, was unchanged. The cesarean rate for nulliparas doubled from 8.3% to 17.5% . The overall neonatal term seizure rate (overall 1.3/1000; and for nulliparas 2.5/1000) did not change. The overall peripartum death rate (0.8/1000) was unchanged, although the rate for nulliparas (1.5/1000) showed a significant decline. Overall seizure rate in nulliparas was 5- fold higher than in multiparas; presumed intra- partum asphyxia was associated with 84% of both seizures and neonatal deaths in nulliparas. Among 2547 prelabor cesarean deliveries, there were no peripartum deaths and one neonatal seizure, an incidence comparable with that in multiparas who labored. Despite a greater than 2- fold rise in cesarean section rate, the seizure rate and overall peripartum death rate at term did not alter significantly. Neonatal seizures occurred 5 times more often following first deliveries.