Obstetrics and gynecology clinics of North America
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The hypothalamic-pituitary-adrenal axis is central to mammalian reproductive function, including conception, pregnancy maintenance, parturition, and breastfeeding. Pregnancy is associated with substantial physiologic changes within this endocrine axis to meet the demands of pregnancy, which include support of the fetus (volume support, nutritional and oxygen supply, clearance of fetal waste), protection of the fetus (from starvation, drugs, toxins), preparation of the uterus for labor, and protection of the mother from potential cardiovascular injury at delivery. This article reviews the anatomy, embryology, and physiology of the pituitary. The effect of pregnancy on pituitary structure and function, in health and disease, also is discussed.
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Obstet. Gynecol. Clin. North Am. · Sep 2004
ReviewTotal laparoscopic hysterectomy and laparoscopic supracervical hysterectomy.
Laparoscopic hysterectomy was first performed in 1989 and has become one of the procedures that may be offered to women with significant gynecologic symptoms. This article describes alternatives to hysterectomy, indications for laparoscopic hysterectomy, and outcomes and complications of laparoscopic hysterectomy as compared with vaginal and abdominal hysterectomy. Surgical technique for both total and supracervical hysterectomy are described as well as the learning curve, training, and credentialing for these procedures.
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Obstet. Gynecol. Clin. North Am. · Jun 2004
ReviewThyroid disease and other endocrine disorders in pregnancy.
Endocrine disorders, in particular, thyroid disorders, are common in pregnancy. The endocrine adaptation to pregnancy, need for adequate iodine supplementation, and thyroxine replacement are presented. In addition, autoimmune diseases of the thyroid and pituitary that may occur subsequent to the immune changes of pregnancy and the postpartum period are discussed. A brief account of the presentation of other endocrine disorders (ie, pituitary,parathyroid, calcium, adrenal and gonadal disorders) also is given, along with their evaluation and management.
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Obstet. Gynecol. Clin. North Am. · Mar 2004
ReviewUltrasound abnormalities of the amniotic fluid, membranes, umbilical cord, and placenta.
Prenatal ultrasound has expanded the ability to assess the umbilical cord, fetal membranes, amniotic fluid volume, and placenta. Evaluation of these structures provides information regarding the intrauterine environment. ⋯ Likewise, placental location or abnormalities may significantly impact obstetric management and prognosis. Early detection of several of these conditions may lead to increased vigilance that may improve perinatal outcome.
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Septic shock, toxic shock syndrome, acute respiratory distress syndrome, and catheter-related infections are conditions in which intensive care management of the patient may be necessary. Toxic shock syndrome is a toxin-mediated illness that is not limited to young menstruating women and should be considered in women and men who present with fever, hypotension, rash, and multiorgan dysfunction. Sepsis is the leading cause of death in critically ill patients in the United States and is the most common predisposing factor for acute lung injury or acute respiratory distress syndrome. Central venous catheters are often a necessity for optimal patient care in these critically ill patients.