American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Mar 1990
Case ReportsPostpartum pulmonary embolus as an unusual cause of cortical blindness.
A pregnant patient was delivered by cesarean section with blindness occurring in the postoperative period. Diagnostic evaluation revealed the presence of massive pulmonary embolus associated with cardiogenic shock. The differential diagnosis of blindness during pregnancy is discussed.
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Am. J. Obstet. Gynecol. · Feb 1990
Clinical guides to preventing ethical conflicts between pregnant women and their physicians.
We provide a justification for preventive ethics in obstetric practice. Four clinical guides to resolving ethical conflicts between pregnant women and their physicians can be identified: (1) informed consent as an ongoing dialogue between the pregnant woman and her physician, (2) negotiation as a clinical strategy, (3) respectful persuasion as a clinical strategy, and (4) the proper use of ethics committees.
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Am. J. Obstet. Gynecol. · Jan 1990
Use of the labor-delivery-recovery room in an urban tertiary care hospital.
Single-room maternity care is an attractive delivery system to obstetricians and consumers. We reviewed the first 15 months' experience in a committed labor-delivery-recovery room unit where all patients were admitted for single-room care regardless of risk. The rate of transfer to a traditional delivery room for vaginal delivery was 3.8%.
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Am. J. Obstet. Gynecol. · Dec 1989
Is a decrease in plasma oncotic pressure enough to explain the edema of pregnancy?
The balance of fluid across capillaries is given by the Starling equation. Because the plasma protein concentration (one of its components) is decreased in pregnancy, we decided to explore the question as to whether hypoproteinemia with intact protein mass (produced by blood volume expansion) or hypoproteinemia with decreased total protein mass (produced by removal of circulating proteins) alters the oncotic pressure differences across capillaries. We calculated the oncotic pressure difference obtained in seven nonpregnant ewes during periods of normoproteinemia and hypoproteinemia; the influence of fluid infusion under both conditions was also observed. ⋯ Capillary permeability was decreased during hypoproteinemia, as evidenced by a higher lymph/protein ratio of labeled albumin during the control period (p less than 0.05). In conclusion, during a state of decreased plasma protein concentration similar to that of pregnancy, the difference in the oncotic pressure and hydrostatic pressure forces acting to prevent transfer of fluid to the interstitium is increased. Therefore other factors that influence fluid transfer across the capillaries must be investigated to explain the edema of pregnancy.
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Am. J. Obstet. Gynecol. · Nov 1989
Meconium aspiration syndrome: intrapartum and neonatal attributes.
To identify the fetus and newborn at risk for meconium aspiration syndrome the perinatal characteristics of 238 infants delivered through meconium-stained amniotic fluid were prospectively examined. All infants with meconium-stained amniotic fluid were routinely suctioned with a DeLee apparatus before tracheal intubation and suctioning. The type and presence of meconium in the trachea, neonatal breathing before intubation, and Apgar scores were recorded in the delivery room. ⋯ The presence of these monitoring findings and thick meconium should alert obstetricians to the possibility of a fetus that requires intervention. Low umbilical artery pH, Apgar scores less than 5, and meconium in the trachea further characterized the newborn at high risk for meconium aspiration syndrome. The combination of these findings may best identify the infant delivered through meconium-stained amniotic fluid who requires close observation for meconium aspiration syndrome.