Obstetrics and gynecology clinics of North America
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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. · Sep 2007
ReviewEarly goal directed therapy for sepsis during pregnancy.
Sepsis is a leading cause of death in pregnancy and results in significant perinatal mortality. These deaths occur despite the younger age of pregnant patients, the low rate of comorbid conditions and the potential for effective interventions that should result in rapid resolution of illness. ⋯ Coordination of care and good communication amongst team members is essential. Incorporation of early goal directed therapy for suspected sepsis into obstetric practice is needed to optimize maternal and neonatal outcomes.
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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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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.