Obstetrics and gynecology clinics of North America
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This article reviews the major reasons for hysterectomies and critiques some of the alternative practices, such as medical therapy to shrink fibroids, and new surgical techniques, such as laparoscopic-assisted hysterectomies. Perhaps in response to the increased attention and the new procedures and drugs that allow more conservative management, the rate of hysterectomies has actually decreased.
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Although most neurologic problems require conservative management, such as headaches and nerve compression syndromes, other demand aggressive treatment, such as plasmapheresis in Guillain-Barré syndrome and prompt surgery in those patients with hemorrhagic strokes secondary to a ruptured aneurysm or arteriovenous malformation. Myasthenia gravis, discussed in the autoimmune disease section, and epilepsy are associated with congenital anomalies, whereas the progeny of patients with multiple sclerosis are at a much greater risk than the general population of contracting this disease. ⋯ Pregnancy provides many physiologic changes that alter the course of preexisting neurologic conditions as well as increasing the risks and morbidity of other diseases. It is for this reason that a cooperative team effort, including the obstetrician, neurologist, and, if needed, the neurosurgeon, is essential for an optimal outcome.
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Disorders of the pituitary gland such as diabetes insipidus, pituitary adenomas, and hyperprolactinemia, disorders of the thyroid gland such as Graves' disease and hypothyroidism, and diseases of the adrenal gland such as adrenocortical insufficiency and Cushing's syndrome can complicate pregnancy. The goals of this article were to provide a basic scientific understanding of the normal function of these endocrine glands, their pregnancy-related changes, and suggestions for diagnosis and treatment of maternal and fetal endocrine disorders during pregnancy. Antenatal recognition and appropriate management of the disorders that especially affect the fetus (i.e., maternal Graves' disease, fetal hypothyroidism, and congenital adrenal hyperplasia) is essential in order to prevent fetal and neonatal morbidity and mortality.
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Obstet. Gynecol. Clin. North Am. · Jun 1991
ReviewRespiratory insufficiency due to pneumonia in pregnancy.
Respiratory insufficiency is a common complication of pneumonia in pregnancy. Respiratory insufficiency may progress to respiratory failure, requiring mechanical ventilation. Prompt diagnosis of the pneumonia and rapid institution of supportive care and effective antimicrobial therapy results in the best possible outcome for both mother and fetus. If the patient requires mechanical ventilation, resolution of the pneumonia usually allows for uneventful weaning from the respirator.
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This article reviews the pathophysiologic changes of pregnancy and pulmonary edema, the clinical findings and diagnostic techniques available to diagnose this condition, and it discusses those areas of obstetrics commonly associated with pulmonary edema. A treatment approach is offered that focuses on the maternal and fetal considerations associated with pulmonary edema.