American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Mar 2009
Randomized Controlled Trial Meta AnalysisImpact of a 'rescue course' of antenatal corticosteroids: a multicenter randomized placebo-controlled trial.
Previous studies using repetitive courses of antenatal corticosteroids (ACS) have demonstrated marginal or no benefit and concern over potential risk. No prior prospective or randomized studies have evaluated the option of a single rescue course of ACS on neonatal outcome. ⋯ Administration of a single rescue course of ACS before 33 weeks improves neonatal outcome without apparent increased short-term risk.
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Am. J. Obstet. Gynecol. · Mar 2009
Comparative StudyGlycine absorption in operative hysteroscopy: the impact of anesthesia.
This study aimed to evaluate the impact of anesthesia on the absorption of glycine in operative hysteroscopy. ⋯ Local anesthesia with sedation is associated with significantly decreased glycine absorption and lower rate of absorption > 500 mL when compared with general anesthesia.
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Spontaneous rupture of an ovarian artery aneurysm is rare and is thought to be related to pregnancy or uterine fibroids. A patient without fibroids presented with extreme pain during normal menstruation. Ruptured ovarian artery aneurysm should be suspected in a multiparous woman with flank or abdominal pain and peritoneal signs.
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Oxytocin is the drug most commonly associated with preventable adverse perinatal outcomes and was recently added by the Institute for Safe Medication Practices to a small list of medications "bearing a heightened risk of harm," which may "require special safeguards to reduce the risk of error." Current recommendations for the administration of this drug are vague with respect to indications, timing, dosage, and monitoring of maternal and fetal effects. A review of available clinical and pharmacologic data suggests that specific, evidence-based guidelines for the intrapartum administration of oxytocin may be derived from available data. ⋯ The use of conservative, specific protocols for monitoring the effects of oxytocin on mother and fetus is likely not only to improve outcomes but also reduce conflict between members of the obstetric team. Implementation of these guidelines would seem appropriate in a culture increasingly focused on patient safety.