European journal of obstetrics, gynecology, and reproductive biology
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Sep 2013
Fetal growth in women with homozygous sickle cell disease: an observational study.
To assess fetal growth and whether lower birthweight to mothers with homozygous sickle cell (SS) disease is related to maternal body composition or to clinical events in pregnancy. ⋯ Lower birthweight in babies of mothers with SS disease is largely the result of the lower gestational age. Fetal sonography showed no growth differences by maternal genotype until 35 weeks' gestation and a reduced crown-heel length in offspring of SS mothers was associated with bone pain crises in pregnancy.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Sep 2013
Review Practice GuidelineDelivery for women with a previous cesarean: guidelines for clinical practice from the French College of Gynecologists and Obstetricians (CNGOF).
The primary cause of uterine scars is a previous cesarean. In women with a previous cesarean, the risks of maternal complications are rare and similar after a trial of labor after cesarean (TOLAC) and after an elective repeat cesarean delivery (ERCD), but the risk of uterine rupture is higher with TOLAC (level of evidence [LE]2). Maternal morbidity in women with previous cesareans is higher when TOLAC fails than when it leads to successful vaginal delivery (LE2). ⋯ In the active phase, it is recommended that the total duration of failure to progress should not exceed 3h; at that point, a cesarean should be performed (professional consensus). Epidural analgesia must be encouraged. The simple existence of a uterine scar is not an indication for a routine manual uterine examination after VBAC (grade C).
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Sep 2013
ReviewGasless laparoscopic surgery during pregnancy: evaluation of its role and usefulness.
The minimally invasive laparoscopic approach in the surgical treatment of diseases during pregnancy has become progressively more accepted and applied. In an attempt to overcome the potential adverse effects of pneumoperitoneum on the fetus, gasless laparoscopic surgery (GLS) has been developed. This article reviews the evidence available for the role and effectiveness of GLS in pregnancy. ⋯ The use of high-pressure continuous suction may prevent the problems that are potentially associated with intra-abdominal smoke generated by electrosurgery, which can increase the risk of fetal exposure to elevated levels of toxic gases. Because this procedure may be performed under regional anesthesia, avoiding general anesthesia, there is a minimal transplacental passage of anesthetic drugs to the fetus. The surgeon must be expert in advanced laparoscopic procedures.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Sep 2013
ReviewMaternal, perinatal and long-term outcomes after assisted reproductive techniques (ART): implications for clinical practice.
The use of assisted reproductive techniques (ART) is on the rise throughout the world and the number of babies born as a result of ART has reached an estimated total of 5 million since the world's first, Louise Brown, was born in 1978. Data from many prospective and retrospective studies have suggested increased risks of adverse maternal, perinatal and long-term outcomes after ART compared to natural conception. ⋯ Clinicians need to remain vigilant about increased risk of pregnancy complications and formulate a plan of care for the woman, from periconception to the puerperium, which aims to prevent or minimise maternal and perinatal morbidity. This review attempts to summarise the available data on reproductive outcomes after ART and provide guidance to the obstetricians and primary care physicians about management of ART pregnancies.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Sep 2013
Randomized Controlled TrialEffects of the addition of low-dose ketamine to propofol-fentanyl anaesthesia during diagnostic gynaecological laparoscopy.
Diagnostic gynaecological laparoscopy (DGL) is a brief procedure, generally performed on an outpatient basis. Propofol-fentanyl is often used for anaesthesia in minor outpatient procedures because of its rapid onset, short duration of action and smooth patient awakening. However, propofol has various cardiovascular effects such as reduced arterial pressure, cardiac output and cardiac index. Ketamine is an intravenous anaesthetic and short-acting analgesic that could alleviate the haemodynamic effects of propofol due to its sympathomimetic activity. The aim of this placebo-controlled trial was to evaluate the effects of the addition of low-dose ketamine to propofol-fentanyl anaesthesia in DGL. ⋯ Use of low-dose ketamine with propofol-fentanyl anaesthesia in patients undergoing DGL was associated with less pain during propofol injection, lower incidence of haemodynamic changes, lower total dose of propofol and improved postoperative analgesia.