Obstetrics and gynecology
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Skillful administration of a well-chosen anesthetic can ease the birth process for the mother, and can possibly prevent such signs of stress in the fetus as bradycardia and asphyxia, which are caused by uterine vasoconstriction. The survey summarizes current knowledge of physiologic changes in pulmonary, cardiac, renal, and other functions during pregnancy and childbirth and the ways in which anesthesia may affect them. Indications and contraindications for the use of various types of anesthesia in normal and complicated deliveries are discussed, as are ways to prevent or minimize adverse reactions in mother and child. This summary facilitates the practicing obstetrician's understanding of the techniques, advantages, and problems involved with obstetric anesthesia and analgesia.
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The authors reviewed all documented cases of bacteremia in obstetric patients between 1975 and 1979, with emphasis on the clinical course. The incidence of bacteremia was 7.5:1000 obstetric admissions and 9.7% of those patients sampled. One hundred seventy-six bacteremic obstetric patients had the following diagnoses: endoparametritis (123), pyelonephritis (29), chorioamnionitis (14), and other (10). ⋯ The patients with chorioamnionitis had a fever index of 32.7 +/- 48.9F-hours and an average hospital stay of 4.8 +/- 2.3 days. These clinical measures are comparable with those in the general population with the same diagnoses at the authors' hospital. In this obstetric population, prompt, vigorous treatment rendered the clinical course of bacteremic patients with genital infections remarkably similar to that of nonbacteremic patients with the same kinds of infection.