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Intérêt de l'extraction instrumentale par voie basse sans anesthésie générale chez des femmes préparées par la méthode psycho-prophylactique.Mezin, Raymond. January 1900 (has links)
Thèse--Méd.--Paris, 1970. N°: 709. / Bibliogr. p. I-III.
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Episiotomy use at operative vaginal deliveryMacleod, Maureen January 2011 (has links)
Episiotomy, a component of operative vaginal delivery (OVD), aims to prevent anal sphincter tears and associated sequelae. Robust evidence suggests restrictive use should be adopted at vaginal delivery but poor quality contradictory evidence exists at OVD. This thesis concerns a series of studies conducted to address this gap in knowledge. Formative work established a priori views and current practice of all obstetricians in the UK and Ireland via a national survey. The majority of clinicians preferred routine use of episiotomy at forceps delivery and restrictive use at vacuum. Respondents indicated support for the planned pilot RCT. A feasibility study established the possibility of conducting a pilot RCT with its known complexities. Data collection tools were developed and found to be fit for purpose and acceptable to women. Shortcomings in the study design informed the proposed pilot RCT. Contemporaneous to the pilot RCT, we conducted a prospective cohort study (n=1360) of morbidity in relation to episiotomy use at OVD to contextualise its findings. Episiotomy was not found to be protective of anal sphincter tears, shoulder dystocia or neonatal trauma but was associated with an increased risk of postpartum haemorrhage [adjusted OR 1.72 (95%CI 1.21 – 2.45)], perineal infection [adjusted OR 4.04 (95%CI 1.44 – 11.37)] and analgesic use [adjusted OR 3.35 (95%CI 2.49 – 4.51)]. The two centred pilot RCT, while not powered to provide definitive evidence, suggested a restrictive approach to episiotomy use does not appear to reduce or greatly increase anal sphincter tears [8.1% vs 10.9%, adjusted OR 0.77, (95% CI 0.28 – 2.10)]. There may however be a difference in effect size and direction between vacuum and forceps use. Routine use was associated with an increase in PPH [36% vs 27%; adjusted OR 1.88, (95% CI 0.99 - 3.57)]. A longitudinal follow up of participants to one year postpartum suggested routine use of episiotomy may decrease rates of urinary morbidity, particularly stress incontinence; dyspareunia; and perineal pain compared to restrictive use. This pilot RCT supports current practice regarding approach to episiotomy use at OVD meantime, pending the results of a definitive study.
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Complaint mechanism modeling and applications with haptic aided evaluationTang, Libo. January 2008 (has links)
Thesis (M. Phil.)--University of Hong Kong, 2008. / Includes bibliographical references (leaf 108-116) Also available in print.
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Modélisation et conception d'un nouveau simulateur d'accouchement (BirthSIM) pour l'entraînement et l'enseignement des jeunes obstétriciens et des sages-femmesSilveira, Ruimark Creazzola Bétemps, Maurice. January 2006 (has links)
Thèse doctorat : Automatique Industrielle : Villeurbanne, INSA : 2004. / Titre provenant de l'écran-titre. Bibliogr. p. 172-187.
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Contração muscular do assoalho pélvico e incontinência urinária em primíparas após o parto vaginal espontâneo e fórcipe = Pelvic floor muscle contraction and urinary incontinence in primiparas with spontaneous and forceps delivery / Pelvic floor muscle contraction and urinary incontinence in primiparas with spontaneous and forceps deliveryAiello, Nathália Andreatti, 1984- 24 August 2018 (has links)
Orientador: Eliana Martorano Amaral / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T09:22:10Z (GMT). No. of bitstreams: 1
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Previous issue date: 2014 / Resumo: Objetivo: Avaliar a influência do parto vaginal espontâneo ou instrumental por fórcipe na contração muscular do assoalho pélvico de primíparas e na incontinência urinária (IU). Métodos: Estudo de coorte prospectivo, realizado no Hospital Universitário da Faculdade de Medicina de Jundiaí (HU-FMJ). Foram selecionadas 133 primíparas, no puerpério imediato, com idade entre 18-35 anos, que tiveram parto vaginal com episiotomia espontâneo ou instrumental por fórcipe. A contração dos músculos do assoalho pélvico (MAP) foi avaliada 40-55 dias após o parto, por meio de eletromiografia de superfície - EMGs (avaliando-se tônus de base ¿ TB, contração voluntária máxima - CVM e contração sustentada média - CSM) e por graduação de força segundo Escala de Oxford Modificada (graus 0-5). Avaliou-se a presença de IU durante a gestação e puerpério, utilizando o Internacional Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). Os métodos estatísticos utilizados foram teste de Qui-Quadrado (X2) ou exato de Fisher para comparar proporções e teste Mann Whitney para comparar médias. Resultados: A média de idade foi de 22,3 anos (±4,2), o IMC gestacional foi de 27,6 Kg/m2 (±5,1). Apenas 44 mulheres realizaram avaliação puerperal, sendo uma descontinuada, 72,1% submetidas ao parto vaginal (PV) e 27,9% ao parto fórcipe (PF). A ocorrência de laceração perineal foi mais frequente no grupo PF (33,3%) do que no grupo PV (3,2%), mas as complicações devidas à episiotomia foram relatadas em apenas 7,0% dos casos, todos no grupo PV. A prevalência de IU foi de 37,6% durante a gestação e 39,5% no puerpério, sendo 32,3% do grupo PV e 58,3% do grupo PF. Houve mais IU desencadeada no puerpério no grupo PF [RR=3,10 (IC=95% 1,16-8,28); p=0,0468]. O sintoma urinário predominantemente referido no puerpério em ambos os grupos foi a urgeincontinência (29,5%), e a média do escore ICIQ foi 2,3 (±3,8) para o grupo PV e 4,2 (±3,9) para o grupo PF, não havendo diferença significativa entre os grupos. Apresentaram grau reduzido de força muscular 66,7% das puérperas do grupo PF e 27,6% do grupo PV. Os valores médios encontrados para TB, CVM e CSM do grupo PV foram 4,6?V, 23,2?V e 16,8?V e do grupo PF 3,4?V, 14,2?V e 10,7?V, respectivamente, havendo diferença significativa para TB e CVM. Conclusão: Entre as mulheres do estudo em questão observou-se associação do parto fórcipe com a diminuição da função dos MAP 40-55 dias após o parto na graduação de força por palpação e parâmetros eletromiográficos de TB e CVM, sem associação com IU / Abstract: Objective: To evaluate the influence of the spontaneous or instrumental vaginal delivery by forceps in the muscular contraction of the pelvic floor of primiparas and urinary incontinence (UI). Methods: Prospective cohort study, carried out in the University Hospital of the Faculty of Medicine of Jundiaí (HU-FMJ). 133 primiparas in the immediate puerperium, aged between 18-35, that have had vaginal delivery with spontaneous or instrumental episiotomy by forceps were selected. The contraction of the pelvic floor muscles (PFM) was evaluated 40-55 days after delivery, by means of surface electromyography - EMGs (evaluating tonus of basis - TB, maximum voluntary contraction - MVC and average of sustained contraction - ASC) and by muscle strenght graduation according to the Modified Scale of Oxford (degrees 0-5). The presence of UI during pregnancy and puerperium was evaluated according to the International Consultation on Incontinence Questionnaire - Short Form (ICIQ-SF). The statistical methods used were the Qui-Square test (X2) or the accurate Fisher indicator to compare ratio and the Mann Whitney test to compare averages. Results: The average age was 22,3 years old (±4,2), gestacional BMI was 27,6 Kg/m2 (±5,1). Only 44 women returned for the puerperal evaluation and one volunteer was discontinued, 72.1% gave birth via spontaneous vaginal delivery (VD) and 27.9% via instrumental vaginal delivery (FD). The occurrence of perineal laceration was more frequent in the FD group (33.3%) than in the VD group (3.2%), but complications due to episiotomy were reported in only 7.0% of the cases, all in the VD group. There were more UI triggered puerperium in the group PF [RR=3,10 (CI=95% 1,16-8,28); p=0,0468]. The prevalence of UI was of 37,6% during pregnancy and 39.5% in the puerperium, where 32,3% of the VD group and 58,3% in the FD group. The urinary symptom predominantly related in the puerperium in both groups was the urge incontinence (29.5%), and the average of the ICIQ score was 2,3 (±3,8) for the VD group and 4,2 (±3,9) for the FD group, without significant differences between the groups. Showed reduced degree of muscular strength 66,7% of the puerperal in the FD group and 27.6% of the VD group. The found average values for TB, MVC and SVC in the VD group was 4,6 ?V, 23,2?V and 16,8?V and in the FD group was 3,4 ?V, 14,2?V and 10,7?V, respectively, with significant difference for TB and MVC. Conclusion: Among the women of the study concerned noted an association of forceps delivery and the reduction of the function of MAP was observed 40-55 days after delivery in the graduation of muscle strenght for palpation and electromyographic parameters of TB and MVC, not associated with UI / Mestrado / Saúde Materna e Perinatal / Mestra em Ciências da Saúde
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Apport du forceps instrumenté dans la sécurité de l'extraction instrumentaleDupuis, Olivier Dittmar, André January 2006 (has links)
Thèse doctorat : Images et Systèmes : Villeurbanne, INSA : 2005. / Titre provenant de l'écran-titre. Bibliogr. p. 225-234.
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Robotique pour l'apprentissage de gestes médicaux mise en oeuvre de séquences d'accouchement automatisées /Olaby, Osama Redarce, Tanneguy. Brun, Xavier. January 2007 (has links)
Thèse doctorat : Automatique Industrielle : Villeurbanne, INSA : 2006. / Titre provenant de l'écran-titre. Bibliogr. p. 169-182.
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Complaint mechanism modeling and applications with haptic aided evaluationTang, Libo., 唐立波. January 2008 (has links)
published_or_final_version / Mechanical Engineering / Master / Master of Philosophy
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Desenvolvimento e caracterização do transdutor piezelétrico de potência e da pinça laparoscópica para o projeto do Bisturi Ultrassônico Nacional / Development and characterization of a high power piezoelectric transducer and laparoscopic forceps for the National Ultrasonic Scalpel ProjectMoretti, Thiago Balan 26 February 2014 (has links)
Este trabalho teve por objetivo desenvolver e caracterizar um conjunto transdutor piezelétrico de potência e pinça laparoscópica para cortes homeostáticos, o qual constitui parte fundamental do projeto do Bisturi Ultrassônico Nacional. O transdutor, do tipo Langevin, é composto por quatro cerâmicas piezelétricas que convertem energia elétrica em deslocamento mecânico. Um componente importante do transdutor é o amplificador mecânico, cuja finalidade é aumentar a amplitude do deslocamento. O transdutor e o amplificador foram desenvolvidos através de um modelo axissimétrico de elementos finitos implementado no software ANSYS e a lâmina foi desenvolvida através de um modelo tridimensional em elementos finitos. Para cada associação, entre os componentes, os resultados numéricos da resposta em frequência da impedância elétrica e do coeficiente de acoplamento eletromecânico, foram comparados com os resultados experimentais. Também foi desenvolvido um mecanismo inovador de acionamento da pinça laparoscópica. O resultado desta pesquisa proporcionou uma inovação tecnológica na área médica, contribuindo assim para o progresso tecnológico do país. / The aim of this work was to develop and characterize a high power piezoelectric transducer coupled to a laparoscopic forceps for homeostatic cuts, which is a fundamental part of the National Ultrasonic Scalpel Project. The Langevin type transducer consists of four piezoelectric ceramics that convert electrical energy into mechanical displacement. An important component of the transducer is the mechanical amplifier, which increases the amplitude of displacement. The transducer and amplifier have been developed through an axisymmetric finite element model, implemented in ANSYS, and the blade was developed using a three-dimensional finite element model. For each association between the components, the numerical results of the frequency response of the electrical impedance and electromechanical coupling coefficient were compared with the experimental results. An innovative drive mechanism was developed for the laparoscopic forceps. The result of this research provided a technological innovation in the medical field, thus contributing to the technological progress of the country.
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Desenvolvimento e caracterização do transdutor piezelétrico de potência e da pinça laparoscópica para o projeto do Bisturi Ultrassônico Nacional / Development and characterization of a high power piezoelectric transducer and laparoscopic forceps for the National Ultrasonic Scalpel ProjectThiago Balan Moretti 26 February 2014 (has links)
Este trabalho teve por objetivo desenvolver e caracterizar um conjunto transdutor piezelétrico de potência e pinça laparoscópica para cortes homeostáticos, o qual constitui parte fundamental do projeto do Bisturi Ultrassônico Nacional. O transdutor, do tipo Langevin, é composto por quatro cerâmicas piezelétricas que convertem energia elétrica em deslocamento mecânico. Um componente importante do transdutor é o amplificador mecânico, cuja finalidade é aumentar a amplitude do deslocamento. O transdutor e o amplificador foram desenvolvidos através de um modelo axissimétrico de elementos finitos implementado no software ANSYS e a lâmina foi desenvolvida através de um modelo tridimensional em elementos finitos. Para cada associação, entre os componentes, os resultados numéricos da resposta em frequência da impedância elétrica e do coeficiente de acoplamento eletromecânico, foram comparados com os resultados experimentais. Também foi desenvolvido um mecanismo inovador de acionamento da pinça laparoscópica. O resultado desta pesquisa proporcionou uma inovação tecnológica na área médica, contribuindo assim para o progresso tecnológico do país. / The aim of this work was to develop and characterize a high power piezoelectric transducer coupled to a laparoscopic forceps for homeostatic cuts, which is a fundamental part of the National Ultrasonic Scalpel Project. The Langevin type transducer consists of four piezoelectric ceramics that convert electrical energy into mechanical displacement. An important component of the transducer is the mechanical amplifier, which increases the amplitude of displacement. The transducer and amplifier have been developed through an axisymmetric finite element model, implemented in ANSYS, and the blade was developed using a three-dimensional finite element model. For each association between the components, the numerical results of the frequency response of the electrical impedance and electromechanical coupling coefficient were compared with the experimental results. An innovative drive mechanism was developed for the laparoscopic forceps. The result of this research provided a technological innovation in the medical field, thus contributing to the technological progress of the country.
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