Gynecologic and obstetric investigation
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Gynecol. Obstet. Invest. · Jan 1997
ReviewLumbar epidural analgesia for labor and vaginal delivery.
Lumbar epidural analgesia has become the preferred method of pain relief for labor and delivery. Proper administration of epidural analgesia offers many advantages for both mother and fetus. With the availability of various local anesthetics, opioids, and infusion techniques, the analgesia can be tailored to the specific needs of the mother, fetus, and labor. Its effect on the progress of labor remains a controversial topic subject to ongoing investigation.
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Gynecol. Obstet. Invest. · Jan 1996
Randomized Controlled Trial Clinical TrialEffect of second-stage 0.25% epidural bupivacaine on the outcome of labor.
To evaluate the effect of second-stage epidural bupivacaine on the outcome of labor. ⋯ The administration of continuous epidural bupivacaine (0.25%) throughout labor and delivery does not seem to affect the outcome of labor.
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Gynecol. Obstet. Invest. · Jan 1996
Case ReportsEarly detection of 'endometrial resection syndrome'.
We report a patient who developed symptoms of fluid overload after having absorbed 3 litres of irrigating fluid during transcervical resection of the endometrium. Four methods were used to measure the absorption at 10-min intervals throughout the operation. ⋯ However, the ethanol method was easiest to perform and provided immediate results. This monitoring gave the operating team as much as 45 min to prevent further absorption before it became large enough to elicit a transcervical endometrial resection syndrome.
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Gynecol. Obstet. Invest. · Jan 1996
Comparative StudyComparative study of transvaginal ultrasonography and hysteroscopy in postmenopausal bleeding.
Twenty-eight women with postmenopausal bleeding were retrospectively studied to assess the accuracy of transvaginal sonography (TVS) and hysteroscopy for diagnosing endometrial pathology. TVS was performed in all patients. Considering a cutoff value of < or = 5 mm as normal, TVS showed normal findings in 14 patients (50%) and suggested endometrial abnormalities in other 14 (50%). ⋯ All patients underwent endometrial biopsy or dilatation and curettage for histopathologic study. Sensitivity, specificity, and positive and negative predictive values for TVS and hysteroscopy were 100, 60.8, 35.7, and 100% and 100, 89.4, 71.4, and 100%, respectively. In our experience, both methods were highly sensitive, but hysteroscopy was more specific than TVS.
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Gynecol. Obstet. Invest. · Jan 1996
Case ReportsCongenital afibrinogenemia with successful delivery.
We experienced a case of congenital afibrinogenemia and successfully performed cesarean section with administration of fibrinogen. The patient was administered fibrinogen every week to sustain a fibrinogen level above 60 mg/ dl according to our previously reported first case. Pregnancy course was uneventful, and fetal growth was normal, but unfortunately placental abruption occurred after the spontaneous onset of labor at 37 weeks gestation. ⋯ During and after the operation, it was increased to 147 and 199 mg/dl, respectively, through infusion of 10 g of fibrinogen, and massive bleeding was stopped. Two grams of fibrinogen were infused daily after cesarean section, and postpartum hemorrhage was normal. It is obvious that fibrinogen is an extremely important factor in maintaining pregnancy, and we conclude that fibrinogen level must be at least 60 mg/dl during pregnancy, 120 mg/dl during surgery and 150 mg/dl during labor, if possible as high as 200 mg/dl under the continuous infusion of fibrinogen to prevent placental abruption.