Obstetrics and gynecology clinics of North America
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Obstet. Gynecol. Clin. North Am. · Jun 2015
ReviewPreeclampsia: Short-term and Long-term Implications.
Preeclampsia is a hypertensive disorder that affects 4% of pregnancies and has a high risk of maternal, fetal, and neonatal morbidity and mortality, as well as long-term cardiovascular risk. Recent updates in the definition, diagnosis, and management guidelines for preeclampsia warrant review by general obstetrician-gynecologists. Screening and prevention algorithms for preeclampsia are available, but ultimately the cure remains delivery of the fetus and placenta. Close monitoring for the development and worsening of preeclampsia during pregnancy is essential to optimize both maternal and fetal/neonatal outcomes.
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Preterm birth (PTB) is a leading cause of neonatal morbidity and mortality. With research efforts, the rate of PTB decreased to 11.4% in 2013. Transvaginal ultrasound (TVU) cervical length (CL) screening predicts PTB. ⋯ In asymptomatic singletons with prior sPTB, serial CL screening is indicated. In multiple gestations, routine cervical screening is not indicated. In symptomatic women with preterm labor, TVU CL screening and fetal fibronectin testing is recommended.
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A maternal mortality rate of 1% was reported during the 2009-2010 influenza pandemic, with influenza in pregnancy posing a serious risk to maternal health. A high level of suspicion coupled with prompt diagnosis and treatment is paramount to minimizing morbidity and mortality. Vaccination during pregnancy should be of high priority to improve both maternal and neonatal outcomes.
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Obstet. Gynecol. Clin. North Am. · Jun 2015
ReviewPlacenta accreta spectrum: accreta, increta, and percreta.
Placenta accreta can lead to hemorrhage, resulting in hysterectomy, blood transfusion, multiple organ failure, and death. Accreta has been increasing steadily in incidence owing to an increase in the cesarean delivery rate. ⋯ Controversies exist regarding optimal management, including optimal timing of delivery, surgical approach, use of adjunctive measures, and conservative (uterine-sparing) therapy. We review the definition, risk factors, diagnosis, management, and controversies regarding placenta accreta.