The Australian & New Zealand journal of obstetrics & gynaecology
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Aust N Z J Obstet Gynaecol · Feb 2012
Practice GuidelineRecommendations for the diagnosis and treatment of deep venous thrombosis and pulmonary embolism in pregnancy and the postpartum period.
Venous thromboembolism (VTE) in pregnancy and the postpartum is an important cause of maternal morbidity and mortality; yet, there are few robust data from clinical trials to inform an approach to diagnosis and management. Failure to investigate symptoms suggestive of pulmonary embolism (PE) is a consistent finding in maternal death enquiries, and clinical symptoms should not be relied on to exclude or diagnose VTE. In this consensus statement, we present our recommendations for the diagnosis and management of acute deep venous thrombosis (DVT) and PE. ⋯ In observational cohort studies, using once-daily regimens appears adequate, in particular with the LMWH tinzaparin; however, pharmacokinetic data support twice-daily therapy with other LMWH and is recommended, at least initially, for PE or iliofemoral DVT in pregnancy. Treatment should continue for a minimum duration of six months, and until at least six weeks postpartum. Induction of labour or planned caesarean section maybe required to allow an appropriate transition to unfractionated heparin to avoid delivery in women in therapeutic doses of anticoagulation.
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Aust N Z J Obstet Gynaecol · Feb 2012
Do primigravidae and their carers have a realistic expectation of uncomplicated labour and delivery?: a survey of primigravidae in late pregnancy, obstetric staff and medical students.
Women who experience unexpected labour and birth interventions describe feeling distressed and have an increased risk of postnatal depression. Primigravidae who have an unrealistic expectation of labour and birth may be at higher risk of these outcomes. ⋯ Primigravidae in late pregnancy and maternity staff do not have a realistic expectation of a labour and birth that is free from medical intervention. This may impact on choices women make about care in pregnancy and labour.
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Aust N Z J Obstet Gynaecol · Feb 2012
Case ReportsAntenatal ultrasound assessment of placental/myometrial involvement in morbidly adherent placenta.
To examine the usefulness of sonographic criteria in the assessment of the lateral extent and depth of myometrial involvement in morbidly adherent placenta. ⋯ Assessment of the placental/myometrial involvement of morbidly adherent placenta is possible on antenatal ultrasound examination. Combinations of different criteria may be required in assessing the lateral extent and the depth of placental/myometrial involvement.