American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · May 1989
Comparative StudyCardiac output in women undergoing cesarean section with epidural or general anesthesia.
Cardiac output during cesarean section and for 24 hours after delivery was estimated by using a noninvasive ultrasonic Doppler technique and was compared between term pregnant patients who underwent either epidural or general anesthesia. Cardiac output peaked by 36.7% and 26.3% of baseline values at 15 and 30 minutes after delivery, respectively, with epidural anesthesia and by 28% and 17.2%, respectively, with general anesthesia. ⋯ This study demonstrates a similar pattern of increase in cardiac output with epidural and general anesthesia and a return by 60 minutes to preoperative levels, which persisted for up to 24 hours after delivery. The applicability of this noninvasive technique can be extended in various circumstances during pregnancy, labor, delivery, and the postpartum period to further define cardiac output in pregnancy.
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Charts of 443 postdate pregnancies were reviewed to determine the effect of late maternal age on pregnancy outcome. There were significantly more low 1-minute Apgar scores, intrapartum decelerations, and cesarean sections in the group of women greater than 35 years old. ⋯ Five-minute Apgar scores also were similar. Women greater than 35 years of age are less able to be delivered of postdate infants with optimal outcomes, but it is still safe to allow them to exceed 42 weeks' gestation.
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Am. J. Obstet. Gynecol. · Mar 1989
Case ReportsRupture and dehiscence of cesarean section scar during pregnancy and delivery.
A prospective study was undertaken to evaluate the risk of uterine rupture or dehiscence after cesarean section. During the 10 years of the study, 24,644 patients were delivered of infants. Of these women, 2036 (8.3%) had previously undergone cesarean section. ⋯ The incidence of uterine dehiscence was 4%. In summary, the risk of uterine rupture in patients who have previously undergone cesarean section but are allowed a trial of labor is low and not associated with serious complications. Vaginal delivery is therefore considered the safest route of delivery in these patients.
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Am. J. Obstet. Gynecol. · Feb 1989
Management of the third stage of labor in pregnancies terminated by prostaglandin E2.
In the management of second-trimester medical terminations of pregnancy, it is a commonly accepted practice to allow 2 hours for the third stage of labor. This practice is based on data from terminations with saline solution as the abortifacient. Herein we report our experience with the use of prostaglandin E2 vaginal suppositories for midtrimester terminations, with particular regard to placental delivery rates and associated complications. ⋯ This was based on an unacceptable complication rate of greater than 4% beyond 2 hours. The present study of the use of prostaglandin E2 suppositories for a variety of indications demonstrated a similar complication rate of 4% at 30 minutes. These findings suggest expectant management beyond this time limit may produce unacceptably high complication rates.
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Am. J. Obstet. Gynecol. · Feb 1989
Format of an obstetrics and gynecology journal club and four years' experience.
Departmental journal clubs have experienced varied degrees of success and longevity. Although a high degree of enthusiasm is difficult to maintain, clear objectives are key factors that encourage active participation. ⋯ On the basis of this experience, we believe a journal club forum offers medical students and residents the optimal opportunity to learn an approach to critical reading of medical reports. In addition, they gain understanding of experimental design and research protocols and ultimately acquire knowledge of the current medical literature.