American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Jul 1991
Case ReportsExtensive pulmonary embolism presenting as severe adult respiratory distress syndrome after surgical resection of a cornual pregnancy.
A rare case of severe adult respiratory distress syndrome associated with a Po2 of 9 mm Hg after surgical resection of a cornual pregnancy at 10 weeks' gestation was treated successfully with positive end-expiratory pressure. The underlying cause, extensive pulmonary embolism, was subsequently revealed. The patient survived without residual brain damage. The possible causes of adult respiratory distress syndrome in pregnancy are discussed.
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Am. J. Obstet. Gynecol. · Jun 1991
Comparative StudyAntibiotic treatment of tuboovarian abscess: comparison of broad-spectrum beta-lactam agents versus clindamycin-containing regimens.
One hundred nineteen patients with tuboovarian abscess were evaluated for response to antibiotics. Results were stratified into three groups by antimicrobial regimen. Group 1 consisted of 37 patients treated with a single-agent broad-spectrum intravenous antibiotic and oral doxycycline. ⋯ There was no statistical difference in the rate of early and late antibiotic failure rates among the groups. Our study demonstrates that extended-spectrum antibiotic coverage, including single-agent broad-spectrum antibiotics such as cefoxitin, in conjunction with doxycycline has efficacy that is equivalent to that of clindamycin-containing regimens. An overall medical treatment success rate of 75% suggests that conservative treatment of tuboovarian abscesses is warranted.
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Am. J. Obstet. Gynecol. · May 1991
Randomized Controlled Trial Clinical TrialThe effect of sterile water blocks on low back labor pain.
To evaluate the analgesic effect of intradermal sterile water blocks, 272 women in labor complaining of severe low back pain were randomly assigned to treatment with either sterile water or saline solution blocks. Pain intensity was assessed on a visual analog scale, before the blocks were given and again 1 and 2 hours later. ⋯ Pain scoring 1 and 2 hours after the blocks were given showed a significantly higher degree of analgesia in the sterile water group. No adverse effects were noted, and patient acceptability was high.
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Am. J. Obstet. Gynecol. · Mar 1991
Randomized Controlled Trial Comparative Study Clinical TrialCombination antimicrobial therapy in the treatment of acute pelvic inflammatory disease.
We compared the clinical and microbiologic efficacy of two broad-spectrum combination antimicrobial regimens in the treatment of 148 patients with acute pelvic inflammatory disease. Patients were randomized to inpatient treatment with either cefoxitin and doxycycline (n = 75) or clindamycin and tobramycin (n = 73). These antibiotics were administered intravenously for at least 4 days, and up to 48 hours beyond defervescence. ⋯ There were no significant differences between antibiotic treatment groups in any response categories or in toxicity. During the initial hospitalization, five patients (three with tuboovarian abscess; one with a pyosalpinx, and one with intractable acute and chronic pelvic inflammatory disease) required surgical intervention. These results support the recommendation to use broad-spectrum combination antimicrobial therapy for the treatment of acute pelvic inflammatory disease.