Obstetrical & gynecological survey
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Obstet Gynecol Surv · Jan 1994
Review Case ReportsNonfatal venous air embolism during cesarean section: a case report and review of the literature.
Venous air embolism occurs in more than half of all cesarean sections. Predisposing factors in pregnancy include uterine surgery and manipulation, hypovolemia, and maternal positioning. The presence of an intracardiac septal defect and use of certain anesthetic agents place the patient at greater risk of fatal air embolus. ⋯ A high index of suspicion and use of precordial Doppler studies in the future will permit earlier diagnosis and therapy and decreased mortality from this common condition. The phenomenon of venous air embolism in the intrapartum period has been well described in the anesthesia literature but there have been few case reports of patients having this complication in the recent obstetrical literature. We wish to describe the clinical course and successful management of a patient with this complication during cesarean section and provide a review of the literature on the phenomenon of venous air embolism in the obstetrical patient with particular emphasis on pathophysiology, detection, and treatment.
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Obstet Gynecol Surv · Jun 1993
ReviewThe role of laparoscopy in chronic pelvic pain: promise and pitfalls.
Published studies relating to the usefulness of diagnostic and operative laparoscopy in women with chronic pelvic pain (CPP) were reviewed. This revealed that approximately 40 per cent of all laparoscopies were done for CPP. However, the definition of CPP was found to be nebulous and inconsistent, and that muddled definitive conclusions about patient diagnoses and treatments. ⋯ The potential roles of each of these abnormalities in CPP were discussed, as well as the results of laparoscopic treatment of each disease. Laparoscopy was also found to have a limited role in women with CPP after hysterectomy or bilateral salpingo-oophorectomy, with usefulness in diagnosing and treating adhesions and residual ovary syndrome, although its role in ovarian remnant syndrome was uncertain. Overall, the data showed that less than 50 per cent of women with CPP were helped by diagnostic and operative laparoscopy, stressing the need for both physicians and patients to recognize that laparoscopy is neither the ultimate evaluation nor the panacea for CPP.
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Obstet Gynecol Surv · Feb 1992
ReviewPerforming tubal sterilizations during women's postpartum hospitalization: a review of the United States and international experiences.
A considerable number of tubal sterilizations have been performed while women are still in hospital after delivery in the United States as well as in other countries. There are few review papers exclusively on this sterilization modality. This paper provides a comprehensive review of results reported from recent studies of this approach, and answers the pertinent medical and related questions such as: To achieve maximum safety, what is the best time to perform the procedure during the women's postpartum hospitalization? Specifically, is it advisable for the procedure to be performed while the woman is still on the delivery table? What surgical approach and tubal occlusion technique are preferred? What are the risks that the women undergoing sterilization immediately or soon after delivery may incur the short- and long-term medical sequelae, and to conceive accidental pregnancy? What effect does sterilization have on lactation? And how should the women be screened and counseled to prevent poststerilization regret, generally thought to be more likely to occur in women after postpartum sterilization? Newly-developed mechanical tubal occlusion techniques have been included for consideration. Practical guidelines are given in this paper to help service providers achieve maximum safety and satisfaction for their patients with this convenient and low-cost method of postpartum sterilization.