Læknaneminn - 01.04.2021, Blaðsíða 115

Rannsóknarverkefni 3. árs nema 2020113
undanhaldi en hækkun varð á nýgengi
garna- og ristilbólgu með drepi (NEC), í
samræmi við $ölgun á fæðingu fyrirbura.
Næst algengasta orsök voru meðfæddar
van skapanir, 87 tilfelli, og af þeim voru
með fæddir hjartagallar flestir. Nýgengi
með fæddra heilagalla hækkaði á meðan
ný gengi litningaþrístæðu sem dánarorsök
dróst alveg saman á 3. tímabili. Fjöldi tilfella
vöggu dauða lækkaði úr 26 tilfellum í 9 milli
1. og 3. tímabils.
Ályktanir: Marktæk lækkun hefur orðið
á ungbarnadauða hér á landi síðustu þrjá
áratugina og er nýgengið eitt það lægsta í
heiminum. Í ljósi þess hve nýgengið er lágt
er erfitt að meta breytingar á nýgengi eftir
dánarorsökum. Niðurstöður benda þó til
þess að vert sé að fylgjast vel með nýgengi
vandamála sem eru algeng dánar orsök
meðal fyrirbura, eins og NEC. Fækkun
dauðsfalla vegna litningagalla og fæðingar-
galla má vafalítið rekja til framfara er varða
fósturskimun. Þrátt fyrir lækkað nýgengi
vöggudauða þá mætti í framtíðinni rann-
saka betur raunverulegar orsakir þeirra
dauðs falla og skoða hvort fyrirbyggja megi
slík dauðsföll. Meðfram þeim breytingum
þarf alltaf að hafa í huga þá siðferðilegu
umræðu um að útrýma ekki genabreytileika
sem ekki er banvænn. Ísland er greinilega
verðugt fordæmi þegar kemur að lágum
ungbarnadauða og athugavert verður að
fylgjast með breytingum sem gætu orðið hér
á landi næstu ár og áratugi.
Brot í nökkvabeini greind á bráðamóttöku
Landspítalans árin 2015-2019
Hilmir Gestsson (Ágrip barst ekki)
Recurrence of Uterine Leiomyomas,
Adhesions and Dehiscence Post
Myomectomy at Time of Cesarean Section
Hjördís Ásta Guðmundsdóttir, Jón Ívar
Einarsson
Introduction: Uterine leiomyomas are
the most common tumor in patients
with a uterus of reproductive age. They
present a major public health problem
due to their high frequency, incidence,
morbidity and affect on fertility. Currently,
leiomyoma recurrence rate is of debate
and pelvic adhesions post myomectomy,
their surgical removal, are defective. The
aim of this retrospective cohort study
was to better understand and describe
recurrence of uterine fibroids, formation
of pelvic adhesions and uterine dehiscence
in patients that had an abdominal (AM)
versus laparoscopic (LM) or robotic-assisted
laparoscopic myomectomy (RALM) at a time
of subsequent cesarean section (CS).
Methods: This was a retrospective chart
review at Brigham and Women’s Hospital
and Partners Hospitals with a history
of myomectomy cases from January 1st
2009 through December 31st 2016 and a
subsequent CS. Recurrence of leiomyoma,
pelvic adhesions and uterine dehiscence
noted in CS operation reports were recorded.
Results: A total of 352 cases were initially
included. Of the 352 cases identified, 47 met
the exclusion criteria. The 305 remaining
cases included 290 cesarean sections and
16 vaginal deliveries. There were 48 (63.2%)
and 68 (29.7%) patients with pelvic adhesions
in the AM and LM/RALM (p-value <0.001),
respectively, demonstrating statistically
less adhesiogenesis in the LM/RALM
group. Uterine dehiscence was observed
in 21 (6.9%) of 305 cases with five (6.6%) and
16 (7.0%) cases in the AM and LM/RALM
groups, respectively. (p=0.868). Estimated
blood loss (EBL) differed by type as mean
EBL was 957.3(432.4)mL in the AM group
and 790.5(332.7)mL in the LM/RALM group
(p=0.001). Recurrence of fibroids occurred
in 105 (33.43%) of the 305 patients included
in the study, thereof were 33 (43.4%) and 72
(31.4%) patients in the AM and LM/RALM
group (p=0.07), respectively. If the number
of previously removed leiomyomas were not
accounted for, the study found LM/RALM
to have a lower OR=0.611 of recurrence,
compared to AM (p=0.0716). Accounting for
the myoma number changed the OR=1.989
(p=0.0801), pointing to the number of
leiomyomas removed in prior myomectomy
to make a significant difference. The
change in OR for each leiomyoma removed,
OR=1.13. Regression analysis of the data
demonstrated that compared to AM,
recurrence of leiomyomas was positively
associated with LM/RALM (OR 2.325, 95%
CI 1.042-5.19), in a statistically significant
fashion. Furthermore, pelvic adhesions
were found to be negatively associated with
LM/RALM (OR 0.289, 95% CI 0.12-0.72).
Conclusion: The study found that at time
of a subsequent cesarean section, patients
with a history of laparoscopic or robotic-
assisted laparoscopic myomectomy were
positively associated with a recurrence
of uterine leiomyomas (OR 2.325, 95% CI
1.042-5.19) when adjusted for confounding
variables, and negatively associated with
pelvic adhesions (OR 0.289, 95% CI 0.12-0.72).,
compared to abdominal myomectomy.
Neonatal Care in Mangochi District
Hospital, Malawi
Ingunn Haraldsdóttir1, Bob Milanzi Faque2,
Þórður Þórkelsson1,3, Geir Gunnlaugsson4
1Faculty of Medicine, University of Iceland,
2Mangochi District Hospital, Malawi, 3Children’s
Hospital, Reykjavík, Iceland and 4Faculty of
Sociology, Anthropology and Folkloristics,
University of Iceland
Introduction: In 2018, globally 18 infants
out of 1,000 live births died in their first 28
days of life, the neonatal period. Neonatal
mortality has reduced substantially during
the last decades, as it was 33 deaths per
1,000 live births in 1990. However, 99%
of neonatal deaths take place in low- and
middle-income countries. Neonatal deaths
are predominantly due to preterm birth and
intra-partum complications, 80% happen
during the first week of life. One of the
United Nations Sustainable Development
Goals is to reduce neonatal mortality to at
least 12 per 1,000 live births, by the year
2030. Current trends suggest that over 60
countries will miss this target. This study
aims to identify some key problems in
neonatal care and how the services can be
improved in a hospital in a sub-Saharan
country.
Methods: Data were collected at the
nursery department of Mangochi District
Hospital in Malawi, where a new maternity
wing, along with a nursery, opened in
January 31, 2019. Study group I included
information on admission, diagnosis and
outcome of all neonates, admitted in the
nursery registry book during the period July
1, 2018 to December 31, 2019. Comparison of
admission rate was made between the Old
and the New nursery, using a binomial test
and the survival rate was compared by using
a chi-square test. The number of admissions
in Study group I were 2,368. Study group
II included information on admission,
diagnosis, treatment and outcome of all
neonates admitted in the nursery in the
period February 20, 2020 to March 11, 2020.
Study group II consisted of 149 neonates.
Furthermore, interviews were conducted
with four health care providers working at
the nursery, during the period, March 12-14,
2020.
Results: In Study group I, there were
625 newborn admissions at the Old nursery
and 1,743 at the New nursery. There were
missing values for all variables, but most
for gestational week, length of stay and
outcome (40-80%), and usually higher in
the Old nursery. Survival rate increased
significantly in the New nursery, compared
to the Old one (82.9% vs. 87.6%, p=0.0039).
There was also a significant change in
average monthly admissions, where
admissions more than doubled (86.4 vs.
177.4, p<0.001). In Study group II, more than
two-thirds were admitted during their first
day of life. Birth asphyxia was the most
common condition, diagnosed in almost
half of the neonates. More than 20% died
in the nursery. In interviews with the
staff, shortage of staff and heavy workload
were mentioned as main challenges at
the workplace. Further, improvement in