Obstetrics and gynecology clinics of North America
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Obstet. Gynecol. Clin. North Am. · Jun 2011
ReviewControversies in the management of placenta accreta.
Obstetric hemorrhage is one of the most common causes of maternal morbidity and mortality worldwide, and abnormal placentation, including placenta accreta, is currently the most common indication for peripartum hysterectomy. Prenatal identification of these cases and early referral to centers with the capability to manage them will likely result in improved outcomes. ⋯ Prospective trials are required to validate the efficacy of this approach. Obstetricians should be familiar with current transfusion protocols, as the incidence of placental accretism is expected to increase in the future.
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Obstet. Gynecol. Clin. North Am. · Jun 2011
ReviewAntenatal exposure to magnesium sulfate and neuroprotection in preterm infants.
Cerebral palsy is a leading cause of childhood neuromotor disability and is strongly associated with preterm delivery. Basic science research and some observational studies have suggested a neuroprotective benefit from antenatal exposure to magnesium sulfate. Recent randomized controlled studies and meta-analyses suggest that antenatal exposure to magnesium sulfate before anticipated preterm birth is associated with reduction in the risk of developing cerebral palsy or its associated neurologic disabilities in surviving infants. More importantly. this benefit has been achieved without increasing the risk of perinatal mortality.
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Obstet. Gynecol. Clin. North Am. · Mar 2011
ReviewUltrasound evaluation of gynecologic causes of pelvic pain.
Ultrasound should be considered the first-line imaging modality of choice in women presenting with acute or chronic pelvic pain of suspected gynecologic or obstetric origin because many, if not most, gynecologic/obstetric causes of pelvic pain are easily diagnosed on ultrasound examination. Since the clinical presentation of gynecologic causes of pelvic pain overlaps with gastrointestinal and genitourinary pathology, referral to CT or MRI, especially in pregnant patients, should be considered if the US examination is nondiagnostic.
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Vaginal bleeding is the most common cause of emergency care in the first trimester of pregnancy and accounts for the majority of premenopausal bleeding cases. Ultrasound evaluation combined with a quantitative beta human chorionic gonadotropin test is an established diagnostic tool to assess these patients. ⋯ A thorough knowledge of the normal sonographic appearance of intrauterine gestation is essential to understand the manifestations of an abnormal gestation. Arteriovenous malformation of the uterus is a rare but important cause of vaginal bleeding in the first trimester, as it has to be differentiated from the more common retained products of conception, with which it is often mistaken.
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Obstet. Gynecol. Clin. North Am. · Sep 2010
ReviewGynecologic surgery and the management of hemorrhage.
Surgical blood loss of more than 1000 mL or blood loss that requires a blood transfusion usually defines intraoperative hemorrhage. Intraoperative hemorrhage has been reported in 1% to 2% of hysterectomy studies. ⋯ This article discusses the methods of preoperative management of anemia, including use of iron, recombinant erythropoietin, and gonadotropin-releasing hormone agonists. The authors have also reviewed the methods of intraoperative and postoperative management of bleeding.