American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Dec 1986
Hemodynamic effects of caval and uterine venous occlusion in pregnant sheep.
In chronically instrumented pregnant ewes we studied the systemic, uterine, and fetal effects of increased uterine venous pressure with and without simultaneous changes in cardiac output, by occluding either the inferior vena cava or both uterine veins. Increased uterine venous pressure with no reduction in venous return of blood to the heart resulted in a reflex increase in arterial blood pressure. ⋯ Uterine blood flow varied in proportion with perfusion pressure at all levels of obstruction. Uterine oxygen consumption and fetal oxygenation only decreased with suprarenal obstruction of the inferior vena cava, when uterine blood flow fell more than 50%.
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Diagnosis and treatment of asymptomatic bacteriuria in pregnant patients can virtually eliminate pyelonephritis, the most common medical cause for antepartum hospitalization. However, the ever-increasing cost of the urine culture has led most clinicians away from routine urine screening. Uricult dip-slide paddles provide an inexpensive, efficient way to screen urine. ⋯ Detection of potential gram-positive pathogens is more difficult. A scheme is proposed that allows reliable, inexpensive surveillance in all pregnant patients. Hopefully, this algorithm will rekindle the obstetrician's interest in urine screening.
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Am. J. Obstet. Gynecol. · Sep 1986
Clinical TrialTherapy of candidal vaginitis: the effect of eliminating intestinal Candida. Nystatin Multicenter Study Group.
A total of 258 patients with candidal vulvovaginitis, all of whom also exhibited Candida organisms in the rectum, were treated for 1 week with vaginal tablets only (nystatin or clotrimazole) or with both vaginal and oral tablets (nystatin). Mycologic and symptomatic responses were superior for the group receiving combined intravaginal-oral therapy; the vaginas of 88% of those treated by both routes were cleared of Candida, as compared with 75% of those receiving only intravaginal medication (p less than 0.05). ⋯ Vaginal infection recurred in 19.7% of patients treated only intravaginally and 14.7% of those receiving combined therapy. These results suggest the value of eliminating any intestinal reservoir of Candida when treating patients with candidal vulvovaginitis.
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Am. J. Obstet. Gynecol. · Sep 1986
von Willebrand's disease and pregnancy: management during delivery and outcome of offspring.
Six patients having different subtypes of von Willebrand's disease were followed up during eight complete pregnancies. Two additional pregnancies terminated in spontaneous abortions. Five pregnancies ended in cesarean section either because of obstetric problems (three) or electively (two) to avoid infant bleeding. ⋯ One of them was born with a head hematoma. Management, which included cryoprecipitate and desmopressin (Stimate), is discussed. It is important to manage each case individually since obstetric parameters and severity of bleeding disorder must be known before treatment is planned.
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Am. J. Obstet. Gynecol. · Aug 1986
Case ReportsPregnancy in a patient with a history of myocardial infarction and coronary artery bypass grafting.
A 37-year-old woman conceived after experiencing a myocardial infarction and undergoing three-vessel aortocoronary artery bypass grafting. Pregnancy was complicated by angina, which was successfully treated with propranolol and bed rest. At term the patient underwent vaginal delivery, without evidence of intrapartum myocardial ischemia or failure.