Ana Reynolds

The modified Misgav-Ladach versus the Pfannenstiel–Kerr technique for cesarean section: a randomized trial

Background.  Modifications to the classic cesarean section technique described by Pfannenstiel and Kerr have been proposed in the last few years. The objective of this trial was to compare intraoperative and short‐term postoperative outcomes between the Pfannenstiel–Kerr and the modified Misgav‐Ladach (MML) techniques for cesarean section.

Self-perceived impact of simulation-based training on the management of real-life obstetrical emergencies

OBJECTIVE To evaluate the self-perceived impact of attending a simulation-based training course on the management of real-life obstetrical emergencies. STUDY DESIGN A prospective follow-up study was conducted. Obstetric nurses and obstetricians (n=54) from a tertiary care university hospital participated in a simulation-based training course for the management of four obstetric emergencies. One year after the last session of the course, participants were asked to complete a questionnaire evaluating the self-perceived impact it had on their knowledge, technical skills, and teamwork skills during experienced real-life situations. A five-point Likert grading scale was used. The χ(2) test with one degree of freedom or the Fishers exact test were used to compare groups of participants. The t-test for independent samples was used to compare mean scores between groups. RESULTS A total of 46 healthcare professionals answered the questionnaire: 27 obstetricians and 19 obstetric nurses. Of these, 87% perceived an improvement (scores 4 or 5) in their knowledge and skills during real emergencies. Obstetric nurses expressed a significantly higher improvement than obstetricians in their ability to diagnose or be aware of obstetrical emergencies (p=0.002), in their technical skills (p=0.024), and in their ability to deal with teamwork related issues (p=0.005). Participants who had experienced in real-life situations all four simulated scenarios rated the impact of training significantly higher than others (p=0.049), and also reported a better improvement in their knowledge of management guidelines (p=0.006). CONCLUSIONS Healthcare professionals who participated in a simulation-based training course in obstetrical emergencies perceived a substantial improvement in their knowledge and skills when witnessing real-life emergencies. Improvements seem to be particularly relevant for obstetric nurses and for those who witness all trained obstetrical emergencies.

Case report: intra-partum utero-ovarian vessels rupture

CaseWe report the rare case of a 39-year-old woman who had an intra-partum hemoperitoneum that resulted from spontaneous rupture of the utero-ovarian vessels. During the expulsive efforts, the patient repeatedly complained of bilateral shoulder discomfort and some respiratory difficulty. Because she had hemodynamic instability and an abdomino-pelvic ultrasound revealed the presence of extensive free fluid within the peritoneal cavity, the patient underwent an exploratory laparotomy. The surgery revealed an extensive laceration of the anterior leaf of the left broad ligament and vesico-uterine peritoneum, and active bleeding from the utero-ovarian vessels with no evidence of uterine rupture.ConclusionIntra-partum haemoperitoneum resulting from rupture of the utero-ovarian vessels is a rare obstetrical emergency that needs rapid resuscitation with fluid and/or blood replacement and prompt surgical intervention.

The modified misgav-ladach versus the pfannenstiel-kerr technique for cesarean section : A randomized trial

BACKGROUND Modifications to the classic cesarean section technique described by Pfannenstiel and Kerr have been proposed in the last few years. The objective of this trial was to compare intraoperative and short-term postoperative outcomes between the Pfannenstiel-Kerr and the modified Misgav-Ladach (MML) techniques for cesarean section. METHODS This prospective randomized trial involved 162 patients undergoing transverse lower uterine segment cesarean section. Patients were allocated to one of the two arms: 88 to the MML technique and 74 to the Pfannenstiel-Kerr technique. Main outcome measures were defined as the duration of surgery, analgesic requirements, and bowel restitution by the second postoperative day. Additional outcomes evaluated were febrile morbidity, postoperative antibiotic use, postpartum endometritis, and wound complications. Students t, Mann-Whitney, and Chi-square tests were used for statistical analysis of the results, and a p < 0.05 was considered as the probability level reflecting significant differences. RESULTS No differences between groups were noted in the incidence of analgesic requirements, bowel restitution by the second postoperative day, febrile morbidity, antibiotic requirements, endometritis, or wound complications. The MML technique took on average 12 min less to complete (p = 0.001). CONCLUSION The MML technique is faster to perform and similar in terms of febrile morbidity, time to bowel restitution, or need for postoperative medications. It is likely to be more cost-effective.

Influence of three organisational measures on the cesarean section rate in a tertiary care University Hospital.

OBJECTIVE To evaluate the influence of three organizational measures on the cesarean section rate over two consecutive years, in the Department of Obstetrics and Gynaecology of a tertiary care University Hospital. MATERIAL AND METHODS Clinical records of births occurring in the years 2001 and 2002 were retrospectively evaluated, in order to identify the annual rate of emergency and elective cesarean sections. Other data recorded were the type of deliveries in each on-call team, newborn 1-min and 5-min Apgar scores, neonatal intensive care unit admissions, principal motive for emergency cesareans, time of day and week-day of emergency cesareans. In the first week of 2002, the results of the first years evaluation were presented to all staff at the Department. At that time, an information pamphlet was distributed to all health care professionals, reminding them of the risks associated with cesarean section. From then on, all emergency cesareans were discussed on the following work-day, in a clinical meeting involving all obstetrical staff. Statistical analysis was carried out using the chi-squared test, with the level of significance being established at 0.05. RESULTS In 2001 there were 3009 births, overall cesarean section rate was 36.5%, and emergency cesarean rate was 30.5%. Cesarean section rates varied between 23.3% and 43.4%, amongst the eight on-call teams. In 2002 there were 2959 births, overall cesarean section rate was 27.6%, and emergency cesarean rate was 20.4%. Cesarean section rates in on-call teams varied between 14.3% and 31.5%. Over the two years, a reduction of 8.9 percentage points (p<0.001) in overall cesarean section rate, and of 10.1 points (p<0.001) in emergency cesareans were observed. During the same period elective cesareans increased 1.2 percentage points (p=0.052) and instrumental deliveries increased 3.2 points (p=0.002). There were less cesarean sections due to arrested labour (154 cases) and non-reassuring fetal state (46 cases), although these motives remained preponderant. The number of newborns with low 1-min Apgar decreased significantly, while those with low 5-min Apgar and intensive care unit admission remained constant. CONCLUSIONS The introduction of three relatively simple organizational measures enabled a significant reduction in the cesarean section rate over a one-year period, without changing the incidence of the main neonatal outcome indicators.