Clinics in perinatology
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Regardless of the cause or degree of renal insufficiency, some common themes have run through the conclusions of many investigators studying chronic renal disease and pregnancy: fetal survival, once thought rare, now appears to be commonplace; maternal renal function, previously thought unlikely to survive a pregnancy, is not adversely affected in the majority of well-managed pregnancies, though the risk of deterioration is still considerable; of all the parameters that can be followed and influenced, maintenance of normotension is the most important. The improvements in maternal and fetal outcome clearly are due to improvements in postnatal care for the neonate, as well as an increased understanding of important risk factors leading to better antepartum maternal management. ⋯ Those choosing to become or continue pregnancy should receive their prenatal care from a team including perinatologists, nephrologists, and neonatologists. Only through a tightly coordinated, team approach can the meticulous care offering the opportunity for successful fetal outcome and minimization of maternal risk be provided.
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This article examines the difficulties of defining perinatal asphyxia. Once the central clinical concern is identified, the ethical questions become clearer. A variety of procedural and ethical issues also need to be considered; especially those related to how physicians introduce and dialogue with parents about difficult life and death decisions. Depending on how well this is accomplished, sound medical practice, parental autonomy and the patient's best interest issues can all be effectively addressed with a minimum of conflict.
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This article discusses the management of short bowel syndrome during the neonatal period. It includes information regarding etiology and pathophysiology and parenteral and enteral nutrition therapy. Finally, a discussion of the role of intestinal transplantation in the treatment of short bowel syndrome is included.
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Clinics in perinatology · Mar 1996
ReviewThe use of ultrasonography in the labor and delivery suite.
Ultrasonography has increasingly become essential in the practice of obstetrics and gynecology. Its antenatal use is well described in the literature and is a continuing subject of study. However, the use of ultrasonography in the labor and delivery suite has not been the subject of many articles. The purpose of this chapter is to review the pertinent literature along with the experience of the authors in order to define the role of ultrasonography in the Labor and Delivery Suite.
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Synthetic oxytocin offers a safe and effective means of producing regular uterine activity and has a fairly large therapeutic index; however, the mild antidiuretic and vasoactive properties of oxytocin increase the risk of water intoxication and hypotension. The issue of reduction in cesarean section rates through the use of an active management protocol is being studied actively in the United States and Canada at this time. ⋯ The longer induction to delivery time demonstrated by some, but not all authors, in our opinion, is a reasonable alternative to avoidable uterine hyperstimulation with the potential for fetal and maternal injury. We advocate the use of the lowest dose necessary to produce adequate uterine contractility and cervical change.