American family physician
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American family physician · Mar 2006
ReviewPreventing postpartum hemorrhage: managing the third stage of labor.
Postpartum hemorrhage is a significant cause of maternal morbidity and mortality. Most postpartum hemorrhages are caused by uterine atony and occur in the immediate postpartum period. Expectant or physiologic management of the third stage of labor has been compared with active management in several studies. ⋯ Good evidence shows that active management of the third stage of labor provides a better balance of benefits and harms and should be practiced routinely to decrease the risk of postpartum hemorrhage. Oxytocin, ergot alkaloids, and prostaglandins have been compared, as have timing and route of administration of these uterotonic medications. Oxytocin is the uterotonic agent of choice; it can be administered as 10 units intramuscularly or as 20 units diluted in 500 mL normal saline as an intravenous bolus, and can safely and effectively be given to the mother with the delivery of the baby or after the delivery of the placenta.
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American family physician · Mar 2006
ReviewAcute finger injuries: part II. Fractures, dislocations, and thumb injuries.
Family physicians can treat most finger fractures and dislocations, but when necessary, prompt referral to an orthopedic or hand surgeon is important to maximize future function. Examination includes radiography (oblique, anteroposterior, and true lateral views) and physical examination to detect fractures. Dislocation reduction is accomplished with careful traction. ⋯ An orthopedic or hand surgeon should treat finger injuries that are unstable or that have rotation. Collateral ligament injuries of the thumb should be examine with radiography before physical examination. Stable joint injuries can be treated with splinting or casting, although an orthopedic or hand surgeon should treat unstable joints.