Current opinion in obstetrics & gynecology
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Some of the topics which have generated particular interest in obstetric anesthesia recently include the effects of epidural anesthesia on the progress of labor, the efficacy of volume preloading prior to spinal anesthesia for cesarean section, and the use of intraspinal opioids and of alpha-2 adrenergic agonists for labor analgesia.
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Curr. Opin. Obstet. Gynecol. · Oct 1994
ReviewVaginal birth after cesarean section: an update on physician trends and patient perceptions.
The increased number of women having a vaginal birth after a cesarean section can be attributed to changing physician trends. Women eligible for vaginal birth after cesarean section include those with previous low vertical incisions, multiple previous incisions and even unknown scars, regardless of the method of closure or previous indication. Limited data suggest that in carefully selected women a current twin gestation, breech presentation, or the presence of fetal macrosomia are not contraindications for a trial of labor, in the presence of a uterine scar. ⋯ External cephalic version and amnioinfusion may also be reasonable alternatives in appropriately selected cases. Despite the documented safety and success of vaginal birth after cesarean section, and the lack of increased morbidity of failed trial of labor, 50% of women who are eligible for vaginal birth after cesarean section will decline an attempt, even after extensive counseling and encouragement. Patient resistance, largely attributed to the fear and inconvenience of labor, is still a major deterrent to a further rise in vaginal birth after cesarean section rates.
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Bacterial vaginosis is a common lower genital tract infection. Women with bacterial vaginosis have 100-1000 times more virulent bacterial per ml of vaginal flora than women without this infection. This tremendous increase in the concentration of bacteria has been recently associated with postpartum and posthysterectomy infection and preterm delivery.
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The common hemorrhagic complications of pregnancy remain among the leading causes of maternal mortality. We review new methods of diagnosis and offer suggestions for management. Abruptio placenta, disseminated intravascular coagulation, placenta previa, uterine rupture, and postpartum hemorrhage are included in this review.
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Regional analgesia and anesthesia for obstetrical patients are undergoing revolutionary changes which will, ultimately, benefit parturients and neonates. These changes have taken place in the arena of techniques, equipment, as well as in medications. This review will cover the management techniques both for vaginal delivery and cesarean section.