European journal of obstetrics, gynecology, and reproductive biology
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Sep 2019
Comparative StudyUterine packing with chitosan-covered gauze compared to balloon tamponade for managing postpartum hemorrhage.
Postpartum hemorrhage (PPH) is a major cause of maternal death worldwide. Management of PPH includes the administration of uterotonics, and intrauterine packing techniques. ⋯ Chitosan covered gauze is an excellent option for treating PPH, it appeared to be at least equivalent to the balloon tamponade, in our experience particularly suitable for atony or placenta bed bleeding after spontaneous delivery or during cesarean sections, in cases of lower uterine segment atony, placenta previa bed bleeding, and/or coagulopathy.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Sep 2019
ReviewNew blood pressure cut off for preeclampsia definition: 130/80 mmHg.
The classical diagnosis of preeclampsia is usually based on the fulfillment of 3 criteria: pregnancy > 20 weeks of gestation, proteinuria (2+ on dipstick or > 300 mg/24 h) and arterial hypertension ≥ 140/90 mm Hg. The current blood pressure cut off of 140/90 mm Hg was set by the American College of Obstetrics and Gynecology (ACOG)-issued practice bulletin of 2019, the 2013 Task Force and the guidelines prompted by the International Society for the Study of Hypertension in Pregnancy (ISSHP). The evidence on which the current cut-off is based is scarce and not updated. We propose the application of the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guidelines on pregnant women and defining preeclampsia with the new 130/80 blood pressure cut-off.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Aug 2019
Analgesia, anaesthesia and obstetric outcome in women with inherited bleeding disorders.
Vertebral canal haematoma (VCH) complicates 1 in 168,000 obstetric epidurals (Ruppen et al., 2006). This risk is increased in women with inherited bleeding disorders (IBD). The impact of a contraindication to regional anaesthesia on pain management and obstetric outcome in these women is unknown. The purpose of this study was to determine anaesthetic use and obstetric outcomes in a cohort of women with IBD. ⋯ Contraindication to neuraxial blockade in labouring women with IBD does not influence mode of delivery. This information is reassuring to these women who may be anxious about delivery without regional anaesthesia.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Jul 2019
Development and initial validation of an electronic personal assessment questionnaire for menstrual, pelvic pain and gynaecological hormonal disorders (ePAQ-MPH).
Menstrual disorders, pelvic-pain and gynaecological hormonal conditions in women can have a significant impact on quality-of-life. Reliable assessment and monitoring of these intimate conditions is challenging. Patient reported outcome measures (PROMs) can be invaluable in providing objective assessment, but no comprehensive PROM assessing all of these conditions and their impact on quality of life is currently available. The purpose of this study was to develop and undertake initial psychometric testing of a comprehensive interactive electronic patient reported outcome measure for these conditions. ⋯ Whilst wider psychometric testing of the revised version of ePAQ-MPH is required, including in different settings and in assessments of data quality and responsiveness, initial analysis provides some evidence for reliability, validity and acceptability of this multi-dimensional electronic PROM. ePAQ-MPH shows potential for both patient assessment and roles in service evaluation and research.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · May 2019
Clinical presentation and management of atypical polypoid adenomyomas: Systematic review of the literature.
The aim of this study is to investigate clinical behavior of Atypical Polypoid Adenomyomas (APAs) and to describe the rates of (i) recurrences, (ii) their association with endometrial hyperplasia and (iii) with endometrial cancer. All studies that reported the outcome of the clinical management of patients with histologically proven APAs were included. A review of the English literature since 1970 was systematically performed (PROSPERO No CRD42018080003). ⋯ In this review, the recurrence rate and the association of APAs with cancer appeared to be higher compared to the previously reported in the literature rates. APAs comprise an intriguing clinical entity that needs individualized treatment, considering the increased association to serious gynecological diseases. Hysterectomy is the appropriate treatment, however uterus-sparing surgery can be offered to selected patients.