American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Aug 2002
ReviewReview of pregnancy labeling of prescription drugs: is the current system adequate to inform of risks?
Evidence-based medicine that is designed to guide benefit/risk drug therapy decisions does not exist for pregnant women. The types of studies that do exist are usually conducted in animals, which may not reflect human benefits and risks. ⋯ This review outlines the difficulties that are associated with the assessment of the benefits/risks of drug therapy during pregnancy, the history of the Food and Drug Administration regulations for labeling prescription drugs, and the strengths and weaknesses of the current Food and Drug Administration pregnancy labeling system. Proposed changes to the current system are reviewed.
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Am. J. Obstet. Gynecol. · Aug 2002
Necrotizing fasciitis in gynecologic and obstetric patients: a surgical emergency.
We reviewed the cases of 23 patients who were admitted to the hospital with a primary diagnosis of histopathologically confirmed necrotizing fasciitis in the lower abdomen or pelvis. Rapid demise of a healthy postpartum women piqued our interest in trying to identify the early signs and symptoms that may lead to earlier diagnosis and treatment of this often fatal disease. ⋯ Necrotizing fasciitis is a rapidly progressive, often lethal, infectious disease process that requires early aggressive debridement. Any patient with inordinate pain and unilateral edema in the pelvis, especially in the puerperium, should be suspected of having this disease. Radiographic studies are often diagnostic of this condition. The triad of pelvic pain, edema, and any sign of septicemia carries an extremely grave prognosis and mandates immediate surgical intervention.
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Am. J. Obstet. Gynecol. · Aug 2002
Factors that are associated with clinically overt postpartum urinary retention after vaginal delivery.
This study was undertaken to determine the incidence of clinically overt postpartum urinary retention after vaginal delivery and to examine what maternal, fetal, and obstetric factors are associated with this problem. ⋯ Clinically overt postpartum urinary retention complicates approximately 1 in 200 vaginal deliveries, with most resolving before hospital dismissal. Factors that are independently associated with its occurrence include instrument-assisted delivery and regional analgesia.
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Am. J. Obstet. Gynecol. · Jul 2002
Randomized Controlled Trial Multicenter Study Clinical TrialDuloxetine versus placebo in the treatment of stress urinary incontinence.
The purpose of this study was to assess the efficacy and safety of duloxetine, a selective inhibitor of serotonin and norepinephrine reuptake, in the treatment of stress urinary incontinence. ⋯ This trial provides evidence for the efficacy and safety of duloxetine as a pharmacologic agent for the treatment of stress urinary incontinence.
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Am. J. Obstet. Gynecol. · Jul 2002
Patient-centered goals for pelvic floor dysfunction surgery: what is success, and is it achieved?
The purpose of this study was to describe patient-identified goals for pelvic floor dysfunction surgical procedures and patient-reported achievement of those goals. ⋯ Women who undergo pelvic floor dysfunction surgical procedures have a variety of desired subjective outcomes. Goals that relate to social roles, sexuality, and self-image may take longer to successfully achieve than other types of goals. Longer-term follow-up is crucial to determine whether initial improvements have been maintained. Assessment of patient goals is quick and easy and may help clinicians better understand and care for their patients.