Premature rupture of membranes in term pregnancy: prognosis, pathogenesis, management of pregnancy and labor

In current article the management of pregnancy and labor with premature rupture of membranes in term pregnancies and pathogenesis of premature rupture of membranes is discussed. The stimulation of labor in 2-3 hours after premature rupture of membranes without biological readiness for labor is not reasonable. In such cases active-observation tactic with antigestagens treatment and adequate antibacterial therapy helps to decrease the number of pathological labor, cesarean section and obstetrical trauma.

VESICO-VAGINAL FISTULA: EXPERIENCE OF 11 YEARS

Objective: To evaluate the outcome of surgical repair in patients with vesico-vaginal fistula at Cipto Mangunkusumo Hospital. Material & Method: A retrospective study of 30 patients with vesico-vaginal fistula, who underwent surgical repair of the fistula at Urology Department Cipto Mangunkusumo Hospital between the period of 1998-2008, were reviewed. Patients were analyzed with regard to age, location of fistula, etiology, size of fistula, and surgical approach. The outcome of the surgery was analyzed. Results: This study included 30 patients who underwent surgery with age between 18-69 years old. The most common etiology was due to obstetrical trauma and hysterectomy. Bladder trigone was the most common location of fistulae (40%). During the surgery the transvesical (43%) approach was commonly used. However, the most excellent outcome was surgery by transvesical-transvaginal approach (100%). Success rate of fistula repair was 73%. Conclusion: This disease is a medically and psychosocially devastating condition for the patient. The diagnosis was easy but complicated in decision of treatment. Best results were observed by transvesical-transvaginal approach. Keywords: Vesico-vaginal fistulae, surgical approach, surgical outcome.