Obstetrics and gynecology clinics of North America
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Acute pulmonary dysfunction and distress is not uncommon in the obstetric patient. In these situations, however, a quick assessment and intervention is necessary in many cases. This article familiarizes the practicing obstetrician with the physiology and therapy to evaluate and effectively treat these patients.
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The anatomic and physiologic changes of pregnancy make the diagnosis and management of abdominal pain difficult. Abdominal conditions both related and unrelated to the pregnancy may be life threatening for mother or fetus; therefore, accurate diagnosis and proper management are essential. This article reviews the most common conditions presenting as acute abdominal pain during pregnancy.
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Obstet. Gynecol. Clin. North Am. · Mar 1995
Acute hypotension related to sepsis in the obstetric patient.
While infections are a common complication of pregnancy, bacteremia and septic shock are relatively rare. Efforts to prevent serious bacterial infections are the most effective means of minimizing maternal and fetal morbidity. Screening for first trimester asymptomatic bacteriuria, prompt and thorough evaluation of suspected bacterial infections, and conscientious intrapartum assessment can have a significant impact in decreasing localized bacterial infections. ⋯ Initial efforts in the treatment of sepsis should be directed at intravascular volume expansion in an effort to improve myocardial performance and tissue oxygenation. Inotropic agents occasionally may be necessary; however, they should be used with caution and only after adequate volume expansion has been provided. Adequate antimicrobial therapy requires treatment with multiagent therapy, providing coverage for the wide variety of genital tract pathogens.
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Obstet. Gynecol. Clin. North Am. · Mar 1995
Management of anesthetic complications and emergencies in the obstetric patient.
The importance of cooperation and understanding between the obstetrician and anesthesiologist in the management of obstetric emergencies cannot be overemphasized. Indications for cesarean section and choice of anesthetic are significant considerations. Algorithms for the management of special treatment problems such as malignant hyperthermia, postdural headache, and epidural abscess and hematoma are presented. Posting of protocols for the management of particular crises in both delivery and postanesthesia care units is strongly recommended.
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Adjuvant therapy has a positive impact in both premenopausal and postmenopausal women with primary breast cancer. Some general principles can be used in making treatment decisions; however, the precise role of adjuvant treatment in breast cancer remains unclear in most clinical settings. Prognostic factors are discussed, along with information on uses of chemotherapy and tamoxifen.