American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Sep 1990
Magnesium sulfate and promethazine do not interact to cause hypotension in gravid ewes.
The purpose of this study was to determine whether magnesium sulfate and promethazine interact to cause hypotension in gravid ewes. Fifteen experiments were performed in five chronically instrumented animals between 125 and 130 days of timed gestation (term = 145 days). In one group of experiments each animal received magnesium sulfate (4 gm intravenous bolus followed by 4 gm/hr intravenous infusion) then promethazine (50 mg intravenously). ⋯ Maternal and fetal arterial blood gas and acid-base values did not change in any group, except that there was a small, near-significant decrease (p = 0.06) in fetal pH 10 minutes after promethazine was given in the magnesium sulfate-promethazine group. We conclude that magnesium sulfate and promethazine did not interact to cause maternal hypotension in normovolemic gravid ewes. However, promethazine increased maternal heart rate and blunted the increase in uterine blood flow associated with magnesium sulfate.
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Am. J. Obstet. Gynecol. · Sep 1990
Comparative StudyA comparison of the effect of epidural, general, and no anesthesia on funic acid-base values by stage of labor and type of delivery.
The effect of epidural anesthesia on neonatal acid-base status, before, during, and after labor, was determined by review of funic blood-gas values from 142 women with normal term pregnancies and normal fetal heart rate patterns. Funic acid-base parameters were compared by type of anesthesia when stratified by mode of delivery (vaginal, cesarean section in the active phase of labor, or elective cesarean section). ⋯ Patients who had elective cesarean section with epidural anesthesia had funic acid-base values similar to women who had general anesthesia. Epidural analgesia-anesthesia offers no clear advantage to the uncompromised term fetus.
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Am. J. Obstet. Gynecol. · Aug 1990
Case ReportsEffect of mitral valve prosthetic surgery on the outcome of a growth-retarded fetus. A case report.
Mitral valve prosthetic surgery was performed at 29 weeks' gestation in a woman who had reoperation for a thrombotic mitral valve prosthesis and pulmonary edema. Concomitant severe preeclampsia was also present. During operation fetal bradycardia developed and the fetus died. Because the findings differ from those previously reported with regard to normal pregnancies, their implications are discussed.
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Am. J. Obstet. Gynecol. · Aug 1990
The impact of a quality assurance process on the frequency and confirmation rate of hysterectomy.
A criteria-based quality assurance process for hysterectomy was instituted at a large teaching hospital. After this process was initiated, the overall frequency of hysterectomy decreased by 24%, p less than 0.001. Significant reductions were seen in hysterectomy rates for the following indications: chronic pelvic pain (77%, p less than 0.0001), recurrent uterine bleeding (46%, p less than 0.001), preinvasive disease of the uterus (55%, p less than 0.005), and severe infection (70%, p less than 0.025). ⋯ This increase, however, was completely reversed during the last 2 years of the study. This quality assurance process also resulted in a significant increase in the histologic verification rate (i.e., 82% vs 93%, p less than 0.001). These observations suggest that using such a criteria-based process can reduce the number of hysterectomies performed and improve the accuracy of the preoperative diagnosis.
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Am. J. Obstet. Gynecol. · Aug 1990
Case ReportsDiabetic ketoacidosis and insulin resistance with subcutaneous terbutaline infusion: a case report.
Diabetic ketoacidosis may occur in women treated with intravenous beta-sympathomimetic agents for tocolysis. We describe diabetic ketoacidosis and transient severe insulin resistance in a woman with diabetes who was treated with subcutaneous terbutaline infusion. Subcutaneous terbutaline infusion may precipitate transient insulin resistance and diabetic ketoacidosis in women with diabetes.