Clinics in perinatology
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Postpartum hemorrhage is an obstetric emergency that represents a major cause of maternal morbidity and mortality. With the recent rise in the cesarean delivery rate, prompt recognition and proper management at the time of cesarean delivery are becoming increasingly important for providers of obstetrics. Preparedness for hemorrhage can be achieved by recognition of prior risk factors and implementation of specific hemorrhage protocols. Medical and surgical therapies are available to treat obstetric hemorrhage after cesarean delivery.
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Four million deliveries occur annually in the United States, and obstetric care has traditionally constituted a substantial portion of medical costs for young women, as well as being a major source of uncompensated care. The economic implications of a large shift in the mode of delivery are potentially important. This article reviews the relevant economic issues surrounding elective cesarean section and cesarean section at maternal request, summarizes the methodological quality and results of current literature on the topic, and presents recommendations for further study.
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Clinics in perinatology · Jun 2008
ReviewLate preterm infants, early term infants, and timing of elective deliveries.
Delivery of infants who are physiologically mature and capable of successful transition to the extrauterine environment is an important priority for obstetric practitioner. A corollary of this goal is to avoid iatrogenic complications of prematurity and maternal complications from delivery. The purpose of this review is to describe the consequences of birth before physiologic maturity in late preterm and term infants, to identify factors contributing to the decline in gestational age of deliveries in the United States, and to describe strategies to reduce premature delivery of late preterm and early term infants.
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Clinics in perinatology · Mar 2008
ReviewComplications of vascular catheters in the neonatal intensive care unit.
Insertion of an intravascular catheter is the most common invasive procedure in the neonatal ICU. With every passing decade, technological innovations in catheter materials and sizes have allowed vascular access in infants who are smaller and sicker for purposes of blood pressure monitoring, blood sampling, and infusion of intravenous fluids and medications. There is, however, growing recognition of potential risks to life and limb associated with the use of intravascular catheters. This article reviews complications of venous and arterial catheters in the neonatal ICU and discusses treatment approaches and methods to prevent such complications, based on current evidence.
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Clinics in perinatology · Mar 2008
ReviewAnesthesia complications in the birthplace: is the neuraxial block always to blame?
This article highlights the common and some of the very serious complications that may occur following neuraxial analgesia for labor and delivery, including headache, backache, infection, hypotension, and hematoma. Total spinal and failed block also are discussed, as are complications unique to epidural anesthesia, such as the intravascular injection of large volumes of local anesthetic (causing seizure or cardiac arrest) and accidental dural puncture.