J Reprod Med
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To evaluate the efficacy of same-day Dilapan insertion prior to nonelective second-trimester dilatation and evacuation. ⋯ Same-day Dilapan insertion prior to planned second-trimester dilatation and evacuation is safe and effective.
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First-trimester vaginal bleeding occurs in approximately 20% of pregnancies and is a frequent cause of emergency department evaluation. Hydatidiform mole, although relatively rare, typically presents as intermittent vaginal bleeding during the first trimester of pregnancy. ⋯ A very rare case of hydatidiform mole with cervical implantation presented as a massive vaginal hemorrhage. The use of stay sutures in a manner similar to cervical cerclage allowed stabilization while further evaluation and treatment were contemplated.
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To determine whether capacitive "stray" currents that can be generated during unipolar laparoscopic electrosurgery are likely to cause unintentional organ injury. ⋯ Our findings can explain unintentional injury during unipolar electrosurgery. The risk of such injury can be reduced by surgeon awareness, low generator output power and use of instruments with ample insulation. Thin insulation is more likely to be encountered with disposable than with multiuse instruments.
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Unintended pregnancies are a recognized occurrence among women using oral contraceptives (OCs) as a consequence of both user and method failure. However, OCs also influence the occurrence of unintended pregnancies through an additional, poorly recognized, route: cessation of OC use by women who do not wish to become pregnant but stop using OCs because of side effects or other reasons. Many such women fail to immediately substitute a new contraceptive and/or adopt a less reliable contraceptive. ⋯ Of continuing OC users, the majority, exhibiting good compliance, contribute 24% of pregnancies because of their large numbers. Continuing OC users who are poor compliers, though many fewer, are responsible for 15% due to their high pregnancy rate. Unintended pregnancies in women who discontinue OCs account for approximately 20% of the 3.5 million annual unintended pregnancies in the United States, incurring costs of nearly +2.6 billion.(ABSTRACT TRUNCATED AT 250 WORDS)
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Review
Differentiating lymphocytic adenohypophysitis from pituitary adenoma in the peripartum patient.
Lymphocytic adenohypophysitis (LAH) is an autoimmune disorder of the pituitary gland with a predilection for the peripartum period and often mimics a pituitary adenoma. We sought to define the clinical, endocrinologic and radiographic characteristics differentiating peripartum LAH from pituitary adenoma to enable the use of noninvasive diagnosis and appropriate therapy. From published reports and our own case, the clinical histories and laboratory and radiographic studies of 45 patients fulfilling the diagnosis of peripartum LAH were reviewed. ⋯ Abnormalities in thyroid and/or adrenal function were also more common in patients with LAH (57.5% vs. 2.5%, P < .001). There were no distinguishing characteristics on radiographic studies. History and endocrinologic evaluation can differentiate between LAH and pituitary adenoma in the peripartum patient.