Search

Review of 1400 epidural anaesthesias during labour and delivery. The single shot method resulted in complete analgesia in 83.8% of the cases. There were 2.8% failures. With longer duration of albour 13.4% of the epidural anaesthesias had to be repeated. Epidural anaesthesia was tolerated well by the women in labour. Hypotension occurred in 21.6% of the cases and was corrected by intravenous infusion and positioning of the patient on the side. No adverse effects on the fetus were found. The duration of labour and delivery was not prolonged. The caesarean section rate was not increased by epidural anaesthesia. Because of the more difficult bearing down reflux during the second stage of labour, the incidence of vacuum extractions was increased by 1 to 3%. The incidence of forceps deliveries remained stable. There was no significant increase of abnormal vertex positions. Postpartum headaches because of decompression by loss of cerebrospinal fluid was seen in 2.2% of the cases. The headaches subsided on complete bed rest. One case of total spinal anesthesia with respiratory arrest is reported which necessitated immediate intubation. Another dangerous complication was noted in a Para 2 who suffered a complete uterine rupture below the level of the epidural anesthesia without any clinical signs and symptoms. Therefore continual internal fetal monitoring is considered to be essential in all cases with epidural anaesthesias. Previous caesarean sections or uterine operations are no contra-indications to epidural anaesthesia.

Report on the rare event of a complete ischemia of the right arm immediately postpartum. The infant was delivered by Caesarean Section because of cervical dystocia and fetal distress. The umbilical cord was twice around the neck and the ischemia of the right arm appeared to be due to spasm of the axillary artery. Treatment for shock and infusion of vasodilating drugs (Complamin) relieved the arterial spasm.

Depressed outpatients (n = 107, age 26-75 years) were treated with either a 50 mg single morning dose of diclofensine (n = 54) or 75-100 mg nomifensine given in two divided doses (n = 53) over a period of three weeks. The baseline mean values of the Depression Status Inventory (DSI index) of Zung corresponded to those of a mildly depressed population, as given by Zung. At the end of the treatment the mean DSI and Anxiety Status Inventory (ASI-index) values of both groups dropped to the levels of a normal population. The side-effect profile of the two treatments was similar. There were no side-effects indicating sedation. Adverse effects of the anticholinergic type were rare. It can be concluded that both diclofensine and nomifensine are beneficial for the treatment of depressed outpatients and that in a dose relation of 2:3 (diclofensine:nomifensine) they lead to a similar improvement in depressive outpatients.

Between 1966 and 1974, 90% of 581 single breech presentations were delivered vaginally. The incidence of Caesarean Section was 9.5%. The overall perinatal mortality was 14%. After elimination of premature deliveries under 1000 grams, stillbirth prior to labour and non-viable anomalies, the perinatal mortality was 5.6%. The perinatal mortality in infants over 2500 grams was 0.69%.

Report on 10,050 gynaecological operations from 1966 to 1978. The operation rate rose from 691 cases in 1966 to 917 cases in 1978. Whereas the rate of vaginal operations remained approximately the same at about 300 cases per year, the rising operative rate consisted of abdominal operations. Contributing were the increasing rate of Caesarean sections, which rose from 2% in 1966, to 8,25% in 1978, and the introduction of diagnostic and therapeutic laparoscopy especially laparoscopic tubal sterilizations. Liberalization of the indications for operation by Kindermann did not occur in our department. A real escalation in the rate of operation did not occur. We do not consider this required nor clinically justifiable. The same is true for our minor gynaecological procedures which did not show significant increases in their rates despite the relative increase in cerclages, conizations and therapeutic abortions. The total mortality was 0.15% and therefore low despite the relatively high incidence of geriatric surgery (9.3%).

Retrospective investigations on 849 low birth weight infants between 1,001 and 2,500 gm born from 1966 to 1982 were done. The infants were divided into three groups with birth weights from 1,001 to 1,500 gm, from 1,501 to 2,000 gm, and 2,001 to 2,500 gm. The results of spontaneous delivery, delivery with manual assistance and caesarian section were compared. In the weight group 1,001 to 1,500 gm (14%), the perinatal mortality was 32%. In caesarian sections, the perinatal mortality was 19%, in spontaneous deliveries the perinatal mortality was 32% and in delivery with manual assistance the perinatal mortality was 45%. In the second weight group of 1,501 to 2,000 gm the perinatal mortality was 14.8%. Spontaneous delivery had a perinatal mortality of 16%, manual assistance a perinatal mortality of 14% and caesarian section a perinatal mortality of 10%. In both birth weight groups of 1,001 to 1,500 gm and 1,001 to 2,000 gm, the infants born by caesarian section had a significantly improved prognosis. Therefore, we recommend caesarian section in these weight groups for all breech presentations. In vertex presentations, caesarian sections are indicated when additional risk factors especially prolonged labour are apparent. In the third weight group between 2,001 and 2,500 gm the overall perinatal mortality was 4.9%. The spontaneously delivered infants have a mortality of 4.1%. Manual assistance was associated with a perinatal mortality of 5.9%. Caesarian section had a perinatal mortality of 11%.(ABSTRACT TRUNCATED AT 250 WORDS)

A case of spontaneous perforation of a tension ulceration in procidentia in an 82 year old woman is reported. A similar case has not been reported in the literature. The extra-ordinary rarity of this observation justifies the publication of this case. The main etiologic factor is considered to be a local perfusion problem of the tissue due to arterial sclerosis of the terminal vessels of the area. The small bowel was replaced. The uterus was replaced. A vaginal packing with clauden and later local treatment of the vaginal ulcers resulted in spontaneous closure of the fistula, histology of the margin of the fistula showed inflammation only and no malignant change. Treatment was completed by a subtotal vaginal colpocleisis according to Labhardt.