J Reprod Med
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To describe the use of colpotomy and the harmonic scalpel in laparoscopic myomectomy and to compare estimated blood loss when using unipolar cautery versus the harmonic scalpel and surgical time for colpotomy versus morcellation. ⋯ These data suggest that the harmonic scalpel is effective for uterine incision during myomectomy and may result in less bleeding than unipolar cautery while offering some advantages in safety. Multiple leiomyomata can generally be extracted more quickly via posterior colpotomy than by morcellation. This difference is smaller and therefore less important in patients with only a few small to medium-sized (< 10 cm) fibroids. For these patients, the minimal invasiveness of morcellation may offer a more significant benefit.
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Abdominal pregnancy is not encountered commonly, and management of the placenta is controversial. ⋯ Placental vasculature embolization is a management option for a retained placenta associated with abdominal pregnancy.
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Comparative Study
Impact of endometriosis on implantation. Data from the Wilford Hall Medical Center IVF-ET Program.
To investigate the effect of endometriosis on implantation. ⋯ For women undergoing in vitro fertilization-embryo transfer with endometriosis, the implantation rate is not markedly different from that for women undergoing in vitro fertilization-embryo transfer with tubal infertility.
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Water retention in a pregnant woman can mirror fetal hydropic changes. This clinical presentation has been named "mirror syndrome." Awareness of the syndrome is important due to the associated fetal and maternal risks. ⋯ Our case, along with 19 reviewed in the literature, reiterate the features of mirror syndrome and provide an opportunity to dispel some of the misconceptions in the literature. The condition is frequently mistaken for preeclampsia, although distinguishing characteristics can be identified. Mirror syndrome is a manifestation of extremely severe fetal hydrops. When the specific cause of fetal hydrops cannot be identified and corrected, immediate delivery is necessary in order to avoid fetal death and maternal complications.
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To assess the safety and efficacy of ritodrine and nitroglycerin for uterine relaxation during cesarean section with a breech-presenting fetus, performed under nongeneral anesthesia. ⋯ Ritodrine and nitroglycerine are safe agents for use at cesarean breech delivery with epidural anesthesia and may be considered for uterine relaxation when a traumatic delivery is anticipated or encountered. Our results do not support the use of these tocolytics for "routine" cesarean breech delivery.