Obstetrics and gynecology clinics of North America
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This article has reviewed the causes and potential therapies for PPH. These include both predictable and unpreventable causes and methods of differential diagnosis. Triage of therapeutic interventions and prompt diagnosis are critical in reducing morbidity and mortality caused by PPH.
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Obstet. Gynecol. Clin. North Am. · Mar 1999
ReviewLaparoscopic tubal sterilization. Methods, effectiveness, and sequelae.
The following statements summarize the material presented herein. 1. Although laparoscopic tubal ligation remains an effective and widely available form of birth control throughout the world, cumulative failure rates may be higher than previously reported, and patients should be appropriately counseled, with special attention to younger women. 2. Proper surgical technique is important in reducing failure rates, particularly with regard to applying clips or using bipolar cautery. ⋯ The data on increased hysterectomies in post-tubal patients may be a result of multiple factors, particularly for women aged less than 30 years at the time of occlusion. 5. Although the majority of women report satisfaction with sterilization, thorough counseling for all women cannot be overemphasized. Women aged less than 30 years should be completely aware of all alternatives and possibly encouraged to try another method prior to permanent sterilization.
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A trend is emerging in the United States whereby surgical procedures are gradually migrating to less complex environments. The demands of cost containment, pressures to limit unnecessary time delays, and desires for increased control have all conspired to promote ambulatory surgicenters, minor procedure center, and office surgical suites. Concomitant with this shift is a differing attitude toward anesthesia, with an increasing number of procedures using alternatives to general anesthesia, such as regional blocks and conscious sedation.
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Obstet. Gynecol. Clin. North Am. · Jun 1998
ReviewPregnancy-related impairments and the Americans with Disabilities Act.
Congress passed the Americans with Disabilities Act (ADA) in 1990. The ADA's overriding purpose is to provide a national mandate for the elimination of discrimination against individuals with disabilities. This article addresses the emerging relationship between pregnancy-related disabilities and the employment provisions of the ADA, set forth in title I of the Act. In view of the high percentage of women who will become pregnant and their potential need for workplace accommodations during and after pregnancy, it is crucial that health professionals understand the impact of the ADA's employment provisions.
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Obstet. Gynecol. Clin. North Am. · Mar 1998
ReviewOpioid dependence during pregnancy. Effects and management.
This article describes the complex problems associated with opioid dependence during pregnancy. Medical, obstetric, and psychosocial problems are presented. Methadone maintenance for the treatment of opioid dependence is described in this article. Specific issues of appropriate methadone dose during pregnancy, medical withdrawal, and the relationship of methadone dose and the severity of neonatal abstinence also are discussed.