Obstetrics and gynecology clinics of North America
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In the successful management of a pregnant Jehovah's Witness, many issues must be addressed beyond those normally required for routine prenatal care. The clinician who undertakes such care should be well versed in the potential complications related to blood refusal, the antepartum management of anemia, and the intrapartum management of obstetric hemorrhage. Furthermore, these patients should be delivered in a tertiary care center because this increases their options for obtaining alternative management of hemorrhage. A woman who is well informed about her options can then decide exactly what she wants done in the event of a life-threatening obstetrical hemorrhage.
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Venous thromboembolism in pregnancy is a clinical emergency that has been associated with significant risk for maternal and fetal morbidity and mortality. The adaptation of the maternal hemostatic system to pregnancy predisposes women to an increased risk of thromboembolism. ⋯ Recent clinical guidelines identify compression venous ultrasound as the best way to diagnose deep venous thrombosis in pregnancy and CT pulmonary angiography as the best way to diagnose pulmonary embolism in pregnancy. Therapy involves supportive care and anticoagulation with unfractionated or low molecular weight heparin, depending on the clinical scenario.
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Postpartum hemorrhage (PPH) is the leading cause of death related to pregnancy worldwide. Most deaths resulting from PPH are preventable. ⋯ Reducing the incidence of PPH and the mortality resulting from the condition should be a key goal of obstetrics services worldwide. This article focuses on the etiology, prediction, prevention, and management of PPH.
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Ectopic pregnancy continues to be one of the most common gynecologic emergencies and is the leading cause of pregnancy-related first-trimester death in the United States. The rate of ectopic pregnancy continues to rise because of increases in the incidences of its risk factors. However, improved modalities of early diagnosis and treatment have reduced both mortality and morbidity of this condition. In this article, the authors present an evidence-based review of the risk factors and presentation of ectopic pregnancy, including the utility of various diagnostic techniques, and compare the appropriateness and effectiveness of different therapeutic approaches.
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Obstet. Gynecol. Clin. North Am. · Mar 2007
ReviewFamily planning American style: why it's so hard to control birth in the US.
The US problems of high unintended pregnancy and abortion can be successfully addressed with a systems approach that focuses on reducing barriers to contraception and improving opportunities to expand access. The ability to reduce unintended pregnancy depends on making family planning services available to all. A comprehensive approach requires policy change to improve funding for and access to family planning, to provide comprehensive sex education and to reduce insurance and religious barriers to contraceptives.