American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Mar 2010
Anterior abdominal wall nerve and vessel anatomy: clinical implications for gynecologic surgery.
We sought to describe relationships of clinically relevant nerves and vessels of the anterior abdominal wall. ⋯ Risk of anterior abdominal wall nerve and vessel injury is minimized when lateral trocars are placed superior to the ASISs and >6 cm from midline and low transverse fascial incisions are not extended beyond the lateral borders of the rectus muscles.
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Am. J. Obstet. Gynecol. · Jan 2010
CommentDiscussion: 'Maternal hypotension during cesarean section' by Maayan-Metzger et al.
In the roundtable that follows, clinicians discuss a study published in this issue of the Journal in light of its methodology, relevance to practice, and implications for future research. Article discussed: Maayan-Metzger A, Schushan-Eisen I, Todris L, et al. Maternal hypotension during elective cesarean section and short-term neonatal outcome. Am J Obstet Gynecol 2010;202:56.e1-5.
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Am. J. Obstet. Gynecol. · Jan 2010
Surgical management of placenta accreta: a cohort series and suggested approach.
The purpose of this study was to describe the use of a staged procedure that involved femoral artery catheterization, classic cesarean section delivery, and uterine and placental embolization before hysterectomy for placenta accreta. ⋯ We found that the successful use of a staged embolization hysterectomy procedure for placenta accreta is associated with decreased maternal morbidity.
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Am. J. Obstet. Gynecol. · Jan 2010
Case ReportsSynchronous autotransfusion during cesarean hysterectomy.
Placenta accreta is associated with major morbidities including massive hemorrhage. We report a cesarean hysterectomy for placenta accreta with synchronous autotransfusion using a standard cardiopulmonary bypass machine. This technique requires complete intraoperative heparinization yet has the advantage of autotransfusion of autologous clotting factors and platelets in addition to red blood cells.
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We conducted an evidence-based review of information about [corrected] amniotic fluid embolism (AFE). The estimated incidence of AFE is 1:15,200 and 1:53,800 deliveries in North America and Europe, respectively. The case fatality rate and perinatal mortality associated with AFE are 13-30% and 9-44%, respectively. ⋯ The hemodynamic response in [corrected] AFE is biphasic, with initial pulmonary hypertension and right ventricular failure, followed by left ventricular failure. Promising therapies include selective pulmonary vasodilators and recombinant activated factor VIIa. Important topics for future research are presented.