J Reprod Med
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Patients presenting with hydatidiform mole are at risk of developing trophoblastic deportation. This clinical syndrome is seen more frequently in patients with uteri greater than 16 weeks in size and/or larger than expected for the gestational age. A pulmonary artery catheter was inserted in a patient, demonstrating the recovery of trophoblast from the pulmonary artery. This invasive technique can aid in the differential diagnosis and precise administration of intravenous fluid in this clinical situation.
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Case Reports
Successful cesarean section in a gravida with the thrombocytopenia with absent radius syndrome. A case report.
A 20-year-old primigravida with the autosomal recessive thrombocytopenia with absent radius (TAR) syndrome was followed in her third trimester of pregnancy. Although the platelet counts ranged from 8,000 to 30,000/microL, the patient had minimal symptoms of peripatellar ecchymoses. She presented at term with spontaneous rupture of the membranes and a double footling breech presentation. ⋯ Antenatal ultrasonography demonstrated normal fetal extremities. Review of the literature revealed this to be the first report of cesarean section in a TAR syndrome patient. Management of coagulation problems should be individualized according to the severity of the disease.
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Four patients presented with ruptured intracranial aneurysms during pregnancy. Problems encountered during the management of these cases included delayed diagnosis, obstructive hydrocephalus, cerebral ischemia due to vasospasm and recurrent subarachnoid hemorrhage. Recent advances in the management of ruptured intracranial aneurysms, including early computerized tomographic scanning, intravascular volume expansion and induced hypertension for the management of cerebral vasospasm, and the timely obliteration of the aneurysm are applicable to the subarachnoid hemorrhage patient even if her condition is complicated by pregnancy.
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In 1981 the American Association of Gynecologic Laparoscopists and the Division of Reproductive Health, Centers for Disease Control, jointly conducted a study of vasectomies performed in outpatient facilities in 1980 in the United States. One hundred twenty-nine facilities that responded to either a mailed questionnaire or a telephone interview stated that vasectomies were performed there in 1980. The average cost was $273, with a range of $50-1,000. ⋯ Freestanding surgical centers reported the use of general anesthesia for 29% of the vasectomies. Other types of facilities were more likely to use local or regional anesthesia. Our data suggest areas for further research to improve the availability and safety of vasectomy.
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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.