Prognosis of congenital diaphragmatic hernia.
Moore A. Umstad MP. Stewart M. Stokes KB.
The Royal Women's Hospital, Melbourne, Victoria.
Congenital diaphragmatic hernia (CDH) contributes significantly to perinatal morbidity and mortality. This retrospective study examines the experience of a major teaching hospital to establish survival rates and factors influencing outcome. Survival rates were found to relate closely to the stage at which the diagnosis was made and the presence of associated anomalies. Ultrasound diagnosis early in pregnancy is associated with a higher mortality rate than diagnosis made late in pregnancy or after delivery. Logistic regression analysis and chi-squared analysis did not establish to a significant degree that any factor, alone or in combination, was a reliable prognostic indicator. It is acknowledged, however, that figures in this series are small. Survival figures are presented to facilitate reliable parental counselling. In particular, the presence of associated major anomalies and the gestational age at which diagnosis is made are of critical importance in accurately counselling parents regarding the prognosis for survival. In this study, excluding terminations, the mortality rate for isolated CDH diagnosis before the 21st week was 45.5%, with a corresponding survival rate of 54.5%. Once the infant was liveborn, however, the survival rate rose to 68.0%, and if the infant survived transfer to a paediatric surgical unit, the survival rate in this study was 73.9 %.
Factors associated with pain following operative laparoscopy: a prospective observational study.
Healey M. Maher P. Hill D. Gebert R. Wein P.
Mercy Hospital for Women, East Melbourne, Victoria.
An open prospective observational study was performed, aiming to measure symptom severity following operative gynaecological laparoscopy and explore any associated factors. Women having concomitant procedures were excluded. Each woman had standardized analgesia, completed a symptom diary for 7 days postoperation, and had a standardized form completed by the surgeon detailing the operation. Back pain, nausea and vaginal pain were found to not be of clinical significance. Cutting major vessels, ligaments, vagina or ovary had major impacts on postoperative symptoms. In the presence of a standardized analgesic regimen, symptoms did not resolve for at least 5 days.
Implications of liver cirrhosis in pregnancy.
Cerqui AJ. Haran M. Brodribb R.
Department of Obstetrics and Gynaecology, Toowoomba Base Hospital, Queensland, Australia.
We present the case of a pregnant woman with alcohol-induced liver cirrhosis and a discussion of the clinically relevant issues of cirrhosis in pregnancy.
Urethral diverticula in pregnancy.
Moran PA. Carey MP. Dwyer PL.
Department of Urogynaecology, Royal Women's Hospital and Mercy Hospital for Women, Melbourne, Victoria, Australia.
In 4 cases, the clinical presentation of urethral diverticulum (UD) during pregnancy was a paraurethral mass (3), urinary incontinence (2), irritative symptoms (2), urinary tract infection (1), urethral pain and discharge (1) and voiding difficulty (1). The diagnosis of UD during pregnancy was made by transvaginal ultrasonography (2), cystoscopy (1), and after pregnancy by a voiding cystourethrogram (1). Management during pregnancy involved antibiotics (2), diverticulum aspiration (2) and incision and drainage (1). Delivery was by the vaginal route in 2 women with diverticular aspiration being performed during the second stage to aid delivery in 1 woman. Caesarean section was performed in the other 2 women for reasons unrelated to the presence of the UD. Three women had diverticulectomy performed following pregnancy for persisting symptoms. Although uncommon, it is important to diagnose urethral diverticula given the associated morbidity and the potential for causing complications during pregnancy.