American journal of obstetrics and gynecology
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Obstetrician/gynecologists often are the initial management clinicians for pelvic neuropathic pain. Although treatment may require comprehensive team management and consultation with other specialists, there are a few critical and basic steps that can be performed during an office visit that offer the opportunity to improve quality of life significantly in this patient population. ⋯ Experimental methods to characterize more precisely the nature of the nerve dysfunction exist to diagnose and treat neuropathic pain; however, additional scientific evidence is needed to recommend these options unanimously. In the meantime, an approach that was adopted from guidelines of the International Association for the Study of Pain has been tailored for gynecologic pain.
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Am. J. Obstet. Gynecol. · Nov 2011
Anesthetic management as a risk factor for postpartum hemorrhage after cesarean deliveries.
This population-based study aimed to compare the risk of postpartum hemorrhage (PPH) for patients who underwent cesarean section delivery (CS) with general vs spinal/epidural anesthesia. ⋯ The odds that women will experience cesarean PPH with general anesthesia are approximately 8.15 times higher than for women who undergo CS with epidural anesthesia.
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We sought to characterize the distribution of the pudendal nerve branches and to correlate findings with injury risk related to common midurethral sling procedures. ⋯ The clitoral and perineal branches of the pudendal nerve should be at low risk of direct nerve injury during midurethral slings and similar procedures as they course caudal to the ventral portion of the perineal membrane. The inferior rectal nerve might be at risk of injury during procedures that involve passage of needles through the ischioanal fossa.