Current opinion in obstetrics & gynecology
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Postpartum haemorrhage remains in the top five causes of maternal deaths in both developed and developing countries. Persistent blood loss of more than 1000 ml should prompt predetermined measures to achieve resuscitation and haemostasis. ⋯ The review discusses in depth the use of misoprostol, recombinant activated factor VII, the uterine tamponade procedures, artery ligation, and uterine haemostatic suturing techniques. It also evaluates the place of interventional radiology and hysterectomy in modern obstetrics.
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Epidural and spinal analgesia for pain relief in labour are now commonplace. Adverse effects such as hypotension and toxicity to anaesthetic agents are well described and easily managed. ⋯ Ethical and methodological difficulties together with an abundance of confounding factors have conspired to cause considerable difficulties for researchers in this area. Nevertheless, recent evidence has significantly advanced knowledge in the field and has implications for future practice.