J Gynecol Obst Bio R
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J Gynecol Obst Bio R · Feb 2004
Review[Cancer and pregnancy: risks of exposure to cancer chemotherapy during pregnancy].
Animal studies reveal that almost all antineoplastic agents are teratogenic. But extrapolation to human beings is not simple because of species differences. ⋯ Adverse effects observed in adult and children are helpful if data during fetal life are lacking. Long-term studies are needed to evaluate the transplacental effects of chemotherapy during pregnancy; these studies should assess the child's mental and physical development, infertility and the occurrence of second malignancies.
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J Gynecol Obst Bio R · Feb 2004
Review[Extremely preterm infants: resuscitation criteria in the delivery room and dialogue with parents before birth].
The resuscitation of extremely preterm infants presents complex medical, social and ethical issues for the families and the health professionals. The principle of a systematic resuscitation "temporary intensive care" does not prohibit the question of a limit in terms of gestational age and birth weight. In France, a do not resuscitate order (comfort care alone) is appropriate for newborns weighing less than 500g and/or with a gestational age of less than 24 weeks' since the mortality is nearly 100%. ⋯ The physician should follow the parents' desires whenever the parents' decision would not obviously violate the infants' best interests. However, they must be informed that decisions about neonatal management made before the delivery can have to be changed in the delivery room, depending on the condition of the neonate at birth. At 25 weeks of gestational age, the prognosis is better and the resuscitation should be more intensive.
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Early administration of analgesics, generally before awakening from general anesthesia is useful to improve the patient's comfort in the post-anesthesia care unit (PACU). Multimodal analgesia includes administration of several analgesics from different pharmacological classes but in almost every combination, morphine or one of its derivatives is included. In the PACU, morphine is titrated using the intravenous route to obtain adequate and rapid pain relief. ⋯ Morphine is often applied using a patient-controlled analgesia device (PCA). After major surgery (especially after radical surgery for malignant disease), intrathecal or epidural analgesia, using a local anesthetic and an opioid is extremely efficient and is combined with other analgesics. Finally, because the affective dimension is extremely important after gynecologic surgery (especially in mutilating interventions), psychologic preparation, patient information and communication are essential components of care.