J Reprod Med
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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.
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Review Comparative Study
Morbidity and mortality from second-trimester abortions.
The comparative safety of methods used to perform second-trimester abortion is an important public health concern. Morbidity and mortality studies have indicated that dilation and evacuation (D&E) is safer than instillation abortion, which is safer than hysterotomy and hysterectomy. ⋯ Little information exists concerning potential late sequelae of second-trimester abortion. D&E appears to be the safest method of second-trimester abortion available in the United States.
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Physicians trained in obstetric anesthesia and no longer practicing it were questioned regarding conditions that were responsible for their leaving the field. A questionnaire was prepared to determine whether the physicians' activity in obstetric anesthesia continued after fellowship training. ⋯ Forty-two percent of the respondents spend more than 40% of their clinical anesthesia time in obstetric anesthesia, and 58% spend less than 40% in it. The reasons for less of an emphasis on obstetric anesthesia were finances, personal matters, lack of recognition, long hours and too much call, and lack of stimulation.
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A patient presented with severe diabetic ketoacidosis at 30 weeks' gestation. Her case was complicated by uterine contractions and fetal distress. Treatment with rehydration and continuous infusion of insulin not only reversed the diabetic ketoacidosis but also stopped the uterine contractions and fetal distress. Ketoacidosis can stimulate uterine contractions and cause signs of fetal distress; these problems can be reversed by adequately treating the diabetic ketoacidosis.
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Abnormal vaginal bleeding in the teenage years usually has nonorganic causes; however, a careful elimination of organic causes is necessary before the diagnosis of dysfunctional uterine bleeding is made. The differential diagnosis in the case of such a complaint and a management plan are discussed.