American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Apr 2003
Cerebral blood flow and metabolism in relation to electrocortical activity with severe umbilical cord occlusion in the near-term ovine fetus.
The purpose of this study was to determine the change in cerebral blood flow and substrate metabolism in relation to electrocortical activity in the near-term ovine fetus with repeated umbilical cord occlusion of a severe degree. ⋯ Severe umbilical cord occlusion in the near-term ovine fetus results in a rapid decrease in the availability of oxygen to the brain. The low PO (2) gradient from blood to tissue rate limits for oxygen consumption by 2 minutes of insult (despite the marked increase in blood flow) and signals the shift to anaerobic metabolism, the suppression in electrocortical activity, and the probable shutdown of other energy-using processes.
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Am. J. Obstet. Gynecol. · Mar 2003
Medical education as a science: the quality of evidence for computer-assisted instruction.
A marked increase in the number of computer programs for computer-assisted instruction in the medical sciences has occurred over the past 10 years. The quality of both the programs and the literature that describe these programs has varied considerably. The purposes of this study were to evaluate the published literature that described computer-assisted instruction in medical education and to assess the quality of evidence for its implementation, with particular emphasis on obstetrics and gynecology. ⋯ Computer-assisted instruction has assumed to have an increasing role in medical education. In spite of enthusiastic endorsement and continued improvements in software, few studies of good design clearly demonstrate improvement in medical education over traditional modalities. There are no comparative studies in obstetrics and gynecology that demonstrate a clear-cut advantage. Future studies of computer-assisted instruction that include comparisons and cost assessments to gauge their effectiveness over traditional methods may better define their precise role.
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Am. J. Obstet. Gynecol. · Mar 2003
Intrapartum fetal heart rate patterns in the prediction of neonatal acidemia.
This study was undertaken to correlate changes in the intrapartum electronic fetal heart rate patterns with the development of significant neonatal acidemia. ⋯ The most significant intrapartum fetal heart rate parameter to predict the development of significant acidemia is the presence of minimal/absent variability for at least 1 hour as a solitary abnormal finding or in conjunction with late decelerations in the absence of accelerations. Urgent delivery should be considered in these cases after appropriate ancillary testing.
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Am. J. Obstet. Gynecol. · Feb 2003
Cohort study of maternal views on future mode of delivery after operative delivery in the second stage of labor.
The purpose of this study was to assess maternal views on the future mode of delivery after either previous instrument vaginal delivery or cesarean delivery at full dilatation. ⋯ A high proportion of women who have had a previous difficult instrument vaginal delivery would still prefer vaginal delivery in a future pregnancy.
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The purpose of this study was to describe our 2-year experience with 483 critically ill peripartum women and to propose a blueprint for obstetric critical care. ⋯ An Obstetric Intermediate Care Unit allows for the continuation of care by obstetricians and results in fewer transfers to medical/surgical intensive care units. Patient treatment depends on hospital size and available resources. In most tertiary centers, the critically ill pregnant woman is best cared for by obstetricians in an Obstetric Intermediate Care Unit. In smaller hospitals, transfer to a medical or surgical intensive care unit may be preferable.