J Reprod Med
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Case Reports
Heterotopic intrauterine and tubal pregnancy complicated by pulmonary embolism. A case report.
A case of heterotopic pregnancy, an unusual condition in itself, complicated by pulmonary embolus is presented. The patient underwent an elective termination of an intrauterine pregnancy and subsequently was diagnosed with a pulmonary embolus, which delayed the diagnosis of her ruptured ectopic pregnancy.
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Patients on a busy obstetric service were prospectively evaluated to determine which ones required blood transfusion. During the period January-April 1990, 5,528 deliveries were performed. Fifty-five patients (0.99%) received blood transfusions during their pregnancy and puerperium. ⋯ The hemorrhage and subsequent need for a blood transfusion were not necessarily due to the procedure except in the case of trauma due to instrumental vaginal delivery. The rate of transfusion of red blood cells for patients undergoing vaginal instrumental delivery was significantly higher than the rate for those undergoing cesarean delivery (relative risk, 2.8; 95% confidence interval, 1.5-5.2). The need for transfusion can be anticipated on the basis of antepartum causes in only 23.7% of patients ultimately receiving blood products.
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Oral contraceptives are a reliable and convenient method of birth control. Nevertheless, physicians are reluctant to use them in women over 35 because of concerns about increased risks of cardiovascular disease, stroke and cancer despite evidence to the contrary. Well-designed studies have shown that the incidence of thromboembolic disease is related to the estrogen dose and that the risk of thromboembolism is highest in women who smoke. ⋯ Oral contraceptives have been shown to protect against endometrial and ovarian cancer. The risk of breast cancer appears to be increased only minimally among current oral contraceptive users. Thus, oral contraceptives offer a safe and effective means of birth control in women over 35, especially in the absence of other risk factors.
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Randomized Controlled Trial Comparative Study Clinical Trial
Treatment of post-cesarean section endometritis with ampicillin and sulbactam or clindamycin and gentamicin.
Seventy-seven patients were prospectively enrolled in a randomized clinical trial to compare two antimicrobial regimens for the treatment of post-cesarean section endometritis. The two groups were not significantly different with respect to age, race, gravidity, parity, hours in labor, cesarean section indication, preoperative or postoperative hemoglobin/hematocrit, pretreatment white blood cell count or pretreatment temperature. Pretreatment urine, blood and endometrial cultures were obtained. ⋯ There were 14 (18%) treatment failures, 7 in each group. Five (36%) of the 14 clinical failures were due to septic pelvic thrombophlebitis, 2 (14%) of the 14 failures were complications of intraabdominal abscesses, and the remaining 7 patients responded after a change in their antibiotic regimen. We conclude that ampicillin/sulbactam and clindamycin/gentamicin are similarly effective for the treatment of post-cesarean section endometritis.
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In order to investigate the androgen and sex hormone binding globulin (SHBG) levels in the polycystic ovary, we compared the total testosterone, free testosterone and SHBG levels in three patterns of polycystic ovary diagnosed with transvaginal ultrasonography (18 in group 1, fewer than 5 cysts identified; 16 in group 2, 5-10 cysts; and 27 in group 3, 10 or more). Free testosterone, but not total testosterone, significantly correlated with body mass index. Androgen levels were found to increase and SHBG levels to decrease with increases in the amount of ovarian cysts, and the evaluation of free testosterone was important in diagnosing the polycystic ovary syndrome.