Obstetrics and gynecology clinics of North America
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Obstet. Gynecol. Clin. North Am. · Sep 2006
ReviewThrombophilia and the risk for venous thromboembolism during pregnancy, delivery, and puerperium.
The main inherited thrombophilias (antithrombin deficiency, protein C and S deficiency, FVL, the prothrombin gene variant, and MTHFR C677T homozygotes) have a combined prevalence in Western European populations of 15% to 20%. One or more of these inherited thrombophilias is usually found in approximately 50% of women who have a personal history of VTE. Obstetricians must therefore be aware of the interaction between thrombophilias and the procoagulant state of pregnancy and should have an understanding of additional risk factors that may act synergistically with thrombophilias to induce VTE. Such knowledge combined with the appropriate use of thromboprophylaxis and treatment in women who have objectively confirmed VTE continue to improve maternal and perinatal outcomes.
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Obstet. Gynecol. Clin. North Am. · Sep 2006
ReviewPeripartum and perioperative management of the anticoagulated patient.
Management of the pregnant patient requiring anticoagulation in the peripartum period represents a significant clinical challenge. The peripartum period includes the most thrombogenic pregnancy-associated state and the intrapartum and immediate postpartum periods, when hemorrhage is and important concern. Clinical decisions depend on the type of antepartum anticoagulation, obstetric factors, risk of hemorrhage, and the risk and implications of thrombosis.
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Obstet. Gynecol. Clin. North Am. · Jun 2006
Comparative StudySimulators and virtual reality in surgical education.
This article explores the pros and cons of virtual reality simulators, their abilities to train and assess surgical skills, and their potential future applications. Computer-based virtual reality simulators and more conventional box trainers are compared and contrasted. The virtual reality simulator provides objective assessment of surgical skills and immediate feedback further to enhance training. With this ability to provide standardized, unbiased assessment of surgical skills, the virtual reality trainer has the potential to be a tool for selecting, instructing, certifying, and recertifying gynecologists.
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This article addresses a challenging diagnostic and treatment dilemma encountered in the care of pregnant women-breast cancer. The treatment of a breast cancer is significantly affected by an ongoing pregnancy and may result in an increased risk for a poor outcome in the mother. The definition, incidence, mechanism, diagnosis, and treatment of breast cancer associated with pregnancy and the normal physiologic and endocrine changes in the breast during pregnancy that contribute to the difficulty encountered by practitioners in diagnosing and treating the disorder are reviewed. The risks associated with pregnancy after breast cancer treatment and the effect of pregnancy on lifetime risk for breast cancer in the general population and for women with mutations in BRCA1 and BRCA2 are also discussed.
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Obstet. Gynecol. Clin. North Am. · Sep 2005
ReviewPreterm premature rupture of the membranes: current approaches to evaluation and management.
Preterm premature rupture of the membranes (PROM) complicates 3% of pregnancies and is responsible for approximately one third of all preterm births. Because preterm PROM presents a clinical situation where early delivery is to be anticipated and prenatal and neonatal complications are common, the physician caring for women with this common obstetric complication has an opportunity to intervene in a manner that can improve perinatal outcome. This article addresses clinically relevant questions regarding the evaluation and management of preterm PROM.