American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Nov 2007
Case ReportsProphylactic balloon occlusion of the internal iliac arteries to treat abnormal placentation: a cautionary case.
Massive hemorrhage from abnormal placentation is a leading cause of postpartum maternal death and hysterectomy after cesarean section. The endovascular surgeon and radiologist are increasingly asked to assist in the management of these complex patients with the placement of bilateral internal iliac artery balloon catheters. ⋯ A review of the vascular and obstetrical literature reveals divergent recommendations for the use of this technique in patients with abnormal placentation. No guidance from rigorous prospective evidence is available and thus we offer recommendations for the cautious use of this modality.
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Am. J. Obstet. Gynecol. · Nov 2007
Randomized Controlled Trial Comparative StudyRandomized trial comparing 3 methods of postoperative analgesia in gynecology patients: patient-controlled intravenous, scheduled intravenous, and scheduled subcutaneous.
The objective of the study was to determine whether any of 3 routes of opioid administration (patient-controlled analgesia [PCA], scheduled intermittent intravenous [i.v.], or scheduled intermittent subcutaneous [s.q.]) provides superior pain relief and satisfaction among patients undergoing abdominal gynecologic surgery. ⋯ Given these findings as well as those in previous literature, no specific method of postoperative analgesia appears to be superior.
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Am. J. Obstet. Gynecol. · Nov 2007
Does a maximum dose of oxytocin affect risk for uterine rupture in candidates for vaginal birth after cesarean delivery?
The purpose of this study was to determine whether the maximum dose of oxytocin impacts the risk of uterine rupture in women who attempt vaginal birth after cesarean delivery (VBAC). ⋯ In VBAC attempts, a dose-response relationship of maximum oxytocin and uterine rupture exists. These results provide evidence for vigilance when higher doses of oxytocin are given to patients who attempt VBAC.
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Am. J. Obstet. Gynecol. · Nov 2007
Implementation of a conservative checklist-based protocol for oxytocin administration: maternal and newborn outcomes.
The purpose of this study was to examine the effects of a conservative and specific checklist-based protocol for oxytocin administration on maternal and newborn outcome. The protocol was based on maternal and fetal response to oxytocin rather than infusion rate. ⋯ Implementation of a specific and conservative checklist-based protocol for oxytocin infusion based on maternal and fetal response results in a significant reduction in maximum infusion rates of oxytocin without lengthening labor or increasing operative intervention. Cesarean delivery rate declined system-wide following implementation of this protocol. Newborn outcome also appears to be improved.