Current opinion in obstetrics & gynecology
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Curr. Opin. Obstet. Gynecol. · Oct 2002
ReviewSacral neuromodulation: new applications in the treatment of female pelvic floor dysfunction.
The first sacral nerve stimulators implanted by Tanagho and Schmidt (1981) were performed for the indications of urinary urge incontinence, urgency-frequency, and nonobstructive urinary retention. Since that time, observations have been made for benefits beyond voiding disorders. These additional benefits have included re-establishment of pelvic floor muscle awareness, resolution of pelvic floor muscle tension and pain, decrease in vestibulitis and vulvadynia, decrease in bladder pain (interstitial cystitis), and normalization of bowel function. ⋯ While the data are encouraging in these new arenas of pelvic floor disorders, investigators acknowledge the need for multicenter, statistically powered studies to evaluate the validity of these findings.
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Curr. Opin. Obstet. Gynecol. · Aug 2002
ReviewComplications in hysteroscopy: prevention, treatment and legal risk.
Fortunately, gynecologists are enthusiastically embracing diagnostic and operative hysteroscopy as a means to evaluate women with menstrual disorders, infertility, post-menopausal bleeding, recurrent pregnancy loss, and for ultrasound images. In general, operative hysteroscopy is a safe procedure, is easily learned, and has excellent surgical outcomes. As more obstetricians/gynecologists perform hysteroscopy, they must remain cognizant about the salient complications. The recognition of complications and prompt intervention will prevent adverse sequelae as well as minimizing undesirable patient outcomes and reducing legal risks. ⋯ The preoperative use of misoprostol or laminara decreases the risk of uterine perforation. Expert preoperative evaluation is essential in determining the surgical skill and expertise needed, surgical time, and the likelihood of completing the operative procedure. Overall, complications in operative hysteroscopy are infrequent and are usually easy to manage. This knowledge should help physicians perform more procedures.
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Curr. Opin. Obstet. Gynecol. · Feb 2002
ReviewThe role of radiation therapy in early endometrial cancer.
Few randomized studies have addressed the best choice of adjuvant radiation therapy after surgery for stage I endometrial cancer. Although whole pelvic radiation decreases the incidence of pelvic and vaginal cancer recurrence, there is no convincing evidence that it improves survival in women who have been completely staged. ⋯ In the absence of randomized trials suggesting that whole pelvic radiation improves survival, it should be limited only to the highest risk stage I subgroups. Vaginal cuff brachytherapy appears to provide excellent local control of disease with minimal morbidity.
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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.