J Gynecol Obst Bio R
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How far providing neonatal intensive care to extremely low birth weight infants is appropriate is still a highly controversial issue. Decision making when a poor prognosis has been established may be facilitated by consensus based recommendations and rigorous procedures. In the very majority of situations, the provision of intensive care is advocated at birth a priori. ⋯ In any case, an ethical policy focused on each infant's best interest is justified, while the adoption of a systematic, gestational age or birth weight based restriction of access to intensive care may not be acceptable in most countries. Rigorous criteria must be fulfilled for end of life decision making and procedures. Continuous assistance to the patient and to the parents is key determinant.
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Since 1996, maternal mortality is registered as part of a permanent confidential inquiry in France. The National Committee has studied all cases recorded to assess the cause of death and the avoidable obstetrical complications involved. Recommendations are proposed. ⋯ The deaths due to amniotic fluid embolism were not considered avoidable. This mortality stemmed from substandard care, delayed treatment, missed diagnosis, and professional errors. Clinical recommendations are proposed for post partum hemorrhage, pre-eclampsia and eclampsia, prevention of maternal infection, and thromboembolism prophylaxy.
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Anesthesia-related mortality in France is being studied in a survey that began in 1996 using the United Kingdom survey as a model. We describe here the deaths reported in these two surveys and discuss the management strategies involved. ⋯ The methodology of the French maternal mortality survey provides data enabling the institution of preventive measures. Specific actions, some of which would require legislation, are proposed to improve maternal safety.
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J Gynecol Obst Bio R · Oct 2001
[Rectal administration of misoprostol for delivery induced hemorrhage. Preliminary study].
Assess the efficacy of one misoprostol tablet (Cytotec) in severe delivery-induced hemorrhage on uterine atony after failure of syntocinon. ⋯ These preliminary findings are encouraging and suggest that further investigations would be useful to assess the beneficial effect of misoprostol by rectal administration for patients with severe delivery-induced hemorrhage due to uterine atony. Case-control studies with a sufficient number of cases should be undertaken to determine the real efficacy of misoprostol in this indication.
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J Gynecol Obst Bio R · Sep 2001
[ Ambulatory laparoscopic gynecological surgery in Africa: feasibility].
We report a prospective survey conduced between March 1998 and February 1999 among 100 women classes ASA I and II who underwent laparoscopic surgery for gynecological disorders under general anesthesia. Among these laparoscopies 85 (85%) were performed for operative purposes and 12 (10.7%) for diagnostic purposes. Minimal monitoring was used (no capnography) so prophylacti fluid loading with 0.9% saline was used before insufflation to reduce hemodynamic changes induced by abdominal overpressure and to avoid potential massive air embolism. ⋯ Twenty-five patients (25%) complained of nausea and vomiting in the recovery room and were treated effectively with metoclopramide. All patients were discharged and accompanied to their home six hours later after a well-tolerated light meal. The postoperative course was uneventful.