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Pregnancy, Delivery and Postpartum
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Katy Kuhrt, Kopal Singhal Agarwal, Chawan Baran, Rebecca Best, Maria Garcia de Frutos, Miranda Geddes-Barton, Laura Bridle, Black Benjamin
Ensure that your patient is clinically stable and there are no significant or concerning signs. The following may be usual symptoms during early pregnancy:Nausea and vomiting – reassure; encourage simple, dry food little and often; and highlight the importance of oral hydration. Refer to hospital if severe dehydration and/or unable to tolerate oral fluids for IV fluid therapyConstipation – encourage oral hydration and offer advice on diet and exercise. Consider laxatives if not improvingIncreased vaginal discharge – follow the vaginal discharge pathway in Section 14.2.Bleeding – spotting might be normal, and vaginal bleeding in early pregnancy is common and often not a cause for concern. Persistent spotting or increase in the amount will need further assessment, as there are important diagnoses to rule out. This is particularly important if working in a remote area when referral may be required or if with a marginalised community where follow-up may not be practical.
Miscarriage
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Erich T. Wyckoff, Hadeer Usama Ebrahem Metwally
Threatened abortion may best be described as vaginal bleeding in the setting of a closed cervix but the diagnostic criteria for spontaneous abortion have not been met. Inevitable abortion refers to cases in which the patient has vaginal bleeding and cervical dilation, typically accompanied by crampy pelvic pain. In this case, products of conception may be visualized protruding through the internal cervical os. Missed abortion refers to a spontaneous abortion in a patient with or without symptoms and with a closed cervical os, with criteria for spontaneous abortion having been met. Incomplete abortion refers to cases in which vaginal bleeding and/or pain are present, the cervix is dilated, and products of conception are found within the cervical canal or have been reported to have passed, but the uterus is not completely evacuated. Complete abortion refers to cases in which the products of conception are entirely evacuated from the uterus and cervix and the cervix is closed on examination. Vaginal bleeding and pain may be mild or resolved.
Pessary Fitting
Published in Teresa Tam, Matthew F. Davies, Vaginal Pessaries, 2019
Problems that may arise following a successful pessary fitting are as follows. Patients may complain of vaginal discharge or odor that is often precipitated by a foreign-body reaction to the pessary. We suggest ruling out acute vaginitis. A topical cream such as Trimo-San cream (Cooper Surgical) or Replens may decrease odor and discharge. If vaginal bleeding occurs, we recommend ruling out a vaginal abrasion or ulcer. If either is present, we would remove the pessary for a period of 2–4 weeks and prescribe vaginal estrogen to allow the area to heal. Resolution of erosions may also occur without local estrogen.10 We also consider a smaller pessary size to prevent bleeding caused by friction. It is important to rule out other sources of bleeding such as uterine or cervical etiology. If the patient experiences pain or urinary or fecal retention, her pessary may be too large, and we suggest downsizing. Finally, upsizing of the pessary may be needed if the pessary is frequently expelled. This can be averted by preventing constipation and minimizing straining in general. Major complications, such as fistula and incarcerated pessaries, are uncommon—91% were related to neglected pessaries.11 Therefore, the importance of continued and diligent follow-up in a patient using a pessary is stressed.
Determinants of low birth weight among newborns delivered in China: a prospective nested case-control study in a mother and infant cohort
Published in Journal of Obstetrics and Gynaecology, 2023
Zhuomin Huang, Quanfu Zhang, Litong Zhu, Haishan Xiang, Depeng Zhao, Jilong Yao
The likelihood of LBW was also increased with vaginal bleeding in the first trimester, a common complication of pregnancy, with a frequency of 16 to 25% (Bondick et al., 2022). Despite its frequency, the risk of adverse outcomes in pregnancies with first-trimester vaginal bleeding remains unclear. Weiss et al. (2004) found that first-trimester vaginal bleeding was an independent risk factor for adverse obstetric outcomes in a population-based screening study of 16,506 patients. Some previous studies have shown a connection between vaginal bleeding during early pregnancy and preterm delivery (Liu et al.2021a, Hackney and Glantz 2011). Vaginal bleeding can cause maternal stress and anxiety, which is linked to a poor pregnancy outcome, and may suggest underlying placental dysfunction, such as altered trophoblast invasion and angiogenesis (Şükür et al.2014). In addition, underlying placental dysfunction may present as preeclampsia, placental abruption, and premature rupture of membranes (PROM).
Single-Incision Plus One Port Laparoscopic Surgery for Myomectomy: A Retrospective Study
Published in Journal of Investigative Surgery, 2023
Gaoli Niu, Hua Zhao, Hong Wang, Lingli Zhao, Yanhong Zhai
Uterine leiomyomas, also called uterine fibroids or myomas, are the most common benign gynecological tumors of women of reproductive age [1]. Although many patients remain asymptomatic, 30–40% develop various symptoms, including irregular vaginal bleeding, pelvic pain, infertility, and pelvic mass, solely due to the size and location of the uterine myomas [2]. Moreover, long-term irregular vaginal bleeding may occur in some patients, which may lead to severe anemia [3,4]. An estimated 26% of patients with uterine leiomyomas become symptomatic and require medical intervention. Although hysterectomy is the most common surgical option in such cases, myomectomy is adopted for women who require uterine-sparing during treatment [5]. This study was undertaken to evaluate the gynecologic endoscopic surgical techniques, including resectoscopic myomectomy, laparoscopic myomectomy, and laparoscopy assisted vaginal hysterectomy, used in the treatment of uterine myomas, with the aim to improve pregnancy outcomes and fewer postoperative complications.
Intrinsic factors contributing to elevated intra-abdominal pressure
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Stefan Niederauer, Grace Hunt, K. Bo Foreman, Andrew Merryweather, Robert Hitchcock
All Study materials were approved by the University of Utah IRB (IRB_00115498) before recruiting women in the greater Salt Lake City area. Women were required to be between the ages of 18 and 54 and able to insert a tampon. Women were excluded if they: (i) experienced bulging beyond the vagina, (ii) had a history of pelvic surgery other than hysterectomy, (iii) currently used a vaginal contraceptive or pessary, (iv) experienced unusual vaginal bleeding or discharge, (v) had a musculoskeletal injury in the last three months, (vi) were pregnant or delivered a baby within the last year, or (vii) had any risk factors related to exercise (PAR-Q (Shephard 1988)). No previous data were available on which to base the statistical design of the study, therefore 12 women were recruited to ensure adequate precision in the means and variances captured in the study while balancing study feasibility and regulatory considerations (Julious 2005).