J Gynecol Obst Bio R
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J Gynecol Obst Bio R · Dec 2004
Review Practice Guideline Guideline[Risk factors of postpartum hemorrhage during labor and clinical and pharmacological prevention].
Prevention of postpartum hemorrhage (PPH) is a major concern in regards to its impact on maternal morbidity and mortality. While established risk factors can be identified among risk factors of PPH during labor after multivariate analysis: prolonged labor, oxytocin stimulation of labor, cesarean section, instrumental delivery, genital lacerations and episiotomy, prolonged third stage of labor, retained placenta; other risk factors are still uncertain: induction of labor, hyperthermia or chorioamniotitis, analgesia or anesthesia, macrosomia, various cesarean section techniques. Isolated identified risk factors have a moderate incidence on PPH, but their cumulation in one patient is a potential high risk. ⋯ The alternative use of prophylactic misoprostol in the third stage of labor is less effective than injectable uterotonics in reducing PPH, and is associated with more side effects (severe shivering, pyrexia, diarrhea). None of other described prophylactic methods have proved efficiency: early suckling, umbilical blood drainage, oxytocin umbilical vein injection, among others. A decrease in PPH prevalence should be obtained by particular attention on data from the early postpartum period, active diffusion of effective prophylactic techniques, and an appropriate choice in regards to each delivery unit organization.
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J Gynecol Obst Bio R · Dec 2004
Practice Guideline Guideline[Anesthesic practices in patients with severe postpartum hemorrhage with persistent or worsening bleeding].
Severe postpartum hemorrhage (PPH) is a rare and critical situation which requires fast and well-planned management where close collaboration between obstetricians and anesthesiologists is essential. In case of persisting or worsening bleeding in spite of initially adequate management, the main goal of the anesthesiologist is to maintain hemodynamic stability (fluid resuscitation, transfusion, vasoactive drugs) and optimal respiratory state (oxygenation) and to correct the frequent clotting disorders, whereas the obstetrician and/or the radiologist have to achieve definitive hemostasis. Assessment of the severity of PPH is determined from: quantity of blood loss and/or duration of bleeding, difficulty in maintaining a correct hemodynamic state in spite of active vascular fluid resuscitation, need for vasoactive therapy and transfusion, occurrence and worsening of clotting disorders. ⋯ A member of the anesthesia team must be present throughout this procedure. At best, a multidisciplinary team, specially trained for this purpose, including obstetrician, anesthesiologist, radiologist and biologist should be available. When one or several invasive treatments were necessary to control the bleeding, it is recommended to transfer the patient to a specialized unit (intensive care unit or recovery room).
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J Gynecol Obst Bio R · Oct 2004
Review Meta Analysis[Magnesium sulfate in obstetrics: current data].
To review the available evidence regarding history, pharmacology, physiology, maternal/fetal side effects, and efficacy of magnesium sulfate in pregnant women. ⋯ The evidence to date confirms the efficacy of magnesium sulfate therapy for women with eclampsia and preeclampsia. However, magnesium sulfate should not be used in order to treat preterm labor.
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J Gynecol Obst Bio R · Sep 2004
Review Case Reports[Management of delivery in patients with Marfan's syndrome presenting aortic dilatation].
We report the anesthesic and obstetrical management of two pregnant patients with Marfan's syndrome. An important dilatation of the root of aorta was established at the beginning of the pregnancy. Based on a review of the literature and our experience, we searched for clues to identify the ideal term and the best mode of delivery, and which type of anesthesia may be the more appropriate in patients with aortic dilatation. ⋯ According to the severity of the aortic dilatation and its evolution, specific management, based on good cooperation between obstetricians and anesthesiologists, is the key of a successful and safe childbirth.