American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Nov 2015
Anatomic variations of pudendal nerve within pelvis and pudendal canal: clinical applications.
The objective of the study was to examine the anatomic variation of the pudendal nerve in the pelvis, on the dorsal surface of the sacrospinous ligament, and in the pudendal canal. ⋯ Great variability exists in pudendal nerve anatomy. Fixation of the pudendal nerve to the dorsal surface of the sacrospinous ligament is a consistent finding; thus, pudendal neuralgia attributed to nerve entrapment may be overestimated. The path of the inferior rectal nerve relative to the pudendal canal may have implications in the development of anorectal symptoms. Improved characterization of the pudendal nerve and its branches can help avoid intraoperative complications and enhance existing treatment modalities for pudendal neuropathy.
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Vasa previa occurs when fetal blood vessels that are unprotected by the umbilical cord or placenta run through the amniotic membranes and traverse the cervix. If membranes rupture, these vessels may rupture, with resultant fetal hemorrhage, exsanguination, or even death. ⋯ Approximately 28% of prenatally diagnosed cases result in emergent preterm delivery. Management of prenatally diagnosed vasa previa includes antenatal corticosteroids between 28-32 weeks of gestation, considerations for preterm hospitalization at 30-34 weeks of gestation, and scheduled delivery at 34-37 weeks of gestation.
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Am. J. Obstet. Gynecol. · Nov 2015
Review Case ReportsChallenging the 4- to 5-minute rule: from perimortem cesarean to resuscitative hysterotomy.
Although perimortem delivery has been recorded in the medical literature for millennia, the procedural intent has evolved to the current fetocentric approach, predicating timing of delivery following maternal cardiopulmonary arrest to optimize neonatal outcome. We suggest a call to action to reinforce the concept that if the uterus is palpable at or above the umbilicus, preparations for delivery should be made simultaneous with initiation of maternal resuscitative efforts; if maternal condition is not rapidly reversible, hysterotomy with delivery should be performed regardless of fetal viability or elapsed time since arrest. ⋯ Even if intrauterine demise has already occurred, maternal resuscitative efforts will typically be markedly improved following delivery with uterine decompression. Consequently we suggest that perimortem cesarean delivery be renamed "resuscitative hysterotomy" to reflect the mutual optimization of resuscitation efforts that would potentially provide earlier and more substantial benefit to both mother and baby.
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The purpose of this study was to characterize male preferences of vulvar appearance, their awareness of labiaplasty, and their knowledge of genital anatomy. ⋯ In this national survey, men demonstrated familiarity with the female anatomy, but many did not feel it impacted sexual desire or pleasure. Moreover, the majority lacked strong preferences for a specific vulvar appearance and would not encourage a female partner to alter her genital appearance surgically.
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Am. J. Obstet. Gynecol. · Nov 2015
Comparative StudyThree-year continuation of reversible contraception.
The objective of this analysis was to estimate the 3-year continuation rates of long-acting reversible contraceptive (LARC) methods and to compare these rates to non-LARC methods. ⋯ Three-year continuation of the 2 intrauterine devices approached 70%. Continuation of LARC methods was significantly higher than non-LARC methods.