J Reprod Med
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Comparative Study Clinical Trial
Naproxen sodium vs. a combination of aspirin, phenacetin, caffeine and codeine phosphate for pain after major gynecologic surgery. A multicenter comparison.
In this multicenter study a nonnarcotic analgesic available for moderate pain, naproxen sodium, 550 mg, was compared to a combination that is used extensively for moderate to severe pain, aspirin, phenacetin, caffeine and codeine phosphate (APC/C) (60 mg of codeine phosphate). Women with pain after major gynecologic surgery reported a similar pattern in pain reduction with the two medications except for a relatively sharper increase in pain intensity between four and six hours after administration of APC/C. A smaller number of patient complaints suggested that naproxen sodium was better tolerated than APC/C.
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Prostaglandin E2 vaginal suppositories are well established in the management of intrauterine fetal demise in the second trimester of pregnancy. However, approval for their use in the third trimester has been withheld pending evaluation of safety and efficacy. In this study 46 patients with intrauterine fetal demise in the third trimester were managed in a similar fashion except that only a 10-mg dose of prostaglandin E2 was employed. ⋯ It appears that prostaglandin E2 vaginal suppositories can be used safely in the management of fetal demise in the third trimester of pregnancy. Use of a lower dose of the medication as well as tocodynamometry is recommended because the absorption of and sensitivity to this medication vary from patient to patient. The frequency of administering the medication should depend on the patient's response rather than on any given formula.
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A predictable pattern of grief follows every perinatal death. Because of their lack of training in the area of death and bereavement, physicians have traditionally avoided acknowledging the grief process in patients who have experienced such a loss. Obstetricians must begin to recognize the appropriate intervention that needs to be instituted in the delivery room and postpartum period to help facilitate the normal grieving process. Physicians must also acknowledge and accept their own feelings of grief and helplessness following a perinatal death.
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Case Reports
Limitations of qualitative serum beta-HCG assays in the diagnosis of ectopic pregnancy.
Seventy-four patients had ectopic pregnancies proven by surgery. Three of them had a serum beta-HCG test for pregnancy that was reported as negative (less than 25-35 mIU/ml). We sought a threshold for positive in the serum beta-HCG test that would maximize its usefulness in diagnosing ectopic pregnancy. ⋯ Lowering the threshold for positive from 25-35 to 10 mIU/ml might increase the test's sensitivity without sacrificing specificity but would still not ensure detection of all ectopic pregnancies. Of 445 cases of ectopic pregnancy described in the literature, 6 had serum beta-HCG values reported as negative. In the published reports and in our own cases, clinical histories and histologies indicated that a nonviable ectopic pregnancy can be expected to have an associated serum concentration of beta-HCG that may be below the sensitivity of detection even with current, commercially available quantitative tests.
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To assess obstetric parameters that would predict successful vaginal delivery in patients with prior cesarean sections, the perinatal records of 579 such patients were reviewed. Sixty-six percent of the patients (385) had elective repeat cesarean sections. Of the 194 patients who attempted vaginal delivery, three-fourths (148) had success. Perinatal parameters that were statistically significant indicators of success included: nonrecurrent indication for cesarean section, vaginal delivery either prior or subsequent to cesarean section, duration of labor less than 24 hours prior to cesarean section, infant's birth weight less than 4,000 gm and cervical dilatation greater than 4 cm on admission for attempted vaginal delivery.