J Reprod Med
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Comparative Study
Advantages and disadvantages of regional anesthesia for cesarean section. A review.
Both epidural and spinal anesthesia have advantages and disadvantages for cesarean section. Compared to general anesthesia, regional offers reduced maternal mortality, the ability to use fewer drugs, more direct experience of childbirth and the capability to decrease blood loss and provide excellent postoperative pain control. The disadvantages of regional anesthesia include hypotension, intraoperative discomfort, post-lumbar-puncture headache and the potential for neurologic and cardiac toxicity from local anesthetics. The choice of which anesthetic technique to employ must depend on maternal preference, the experience and skills of the anesthesiologist, and the obstetric indication for the cesarean section.
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Premature rupture of the membranes remains a significant problem area in obstetrics. When the fetal lung maturity is inadequate and there is no evidence of intrauterine infection, a delay in delivery is recommended. ⋯ Assays for phosphatidylglycerol in amniotic fluid collected from the vagina are most helpful in determining the maturity status. Therapeutic agents to accelerate lung maturity, stop labor or prevent infections must be considered investigational when used during the latency phase of premature rupture of the membranes.