Obstetrics and gynecology
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There is some concern that providing parturients with epidural analgesia increases the likelihood of cesarean delivery. Because of the widespread interest in cesarean rates and the expanding use of epidural analgesia, we believed that this contention should be assessed. Hospital records were reviewed to determine the primary cesarean rate for 1084 parturients who delivered at our institution during 15 months in which there was a 24-hour "on demand" epidural service. ⋯ For patients in labor, the primary cesarean rate overall was 9.0% before and 8.2% after the epidural service began (P = .626). When subpopulations based on parity and indication for cesarean delivery were studied, there were no significant changes in the cesarean rate. These results demonstrate that the availability of on-demand epidural analgesia for patients in labor did not increase the primary cesarean rate, either in the aggregate or for any of the subpopulations studied.
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Obstetrics and gynecology · Aug 1991
Inguinal endometriosis: pathogenetic and clinical implications.
In six women with a preoperative diagnosis of incarcerated hernia, surgical exploration of the groin revealed inguinal endometriosis and no hernia. The affected structure was always the extraperitoneal portion of the round ligament. Six of the seven lesions were on the right. ⋯ Catamenial pain was the pathognomonic symptom in the differential diagnosis of the inguinal mass. Gynecologists and surgeons should bear in mind the possibility that endometriosis may be the cause of symptoms of a suspected incarcerated inguinal hernia. Should this disease be detected at inguinal exploration, a laparoscopy is indicated during the same operation.
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Obstetrics and gynecology · Aug 1991
Pulmonary function of preeclamptic women receiving intravenous magnesium sulfate seizure prophylaxis.
Pulmonary function was studied in ten preeclamptic women in labor (mean gestational age 38.1 +/- 0.9 weeks measured from the last menstrual period) receiving continuous intravenous (IV) infusions of magnesium sulfate. Baseline maximal inspiratory pressure, maximal expiratory pressure, functional vital capacity, and forced expiratory volume at 1 second were measured immediately before a 6-g IV loading dose of magnesium sulfate and 2 hours after the initiation of a continuous 2-g/hour infusion of magnesium sulfate. Serum magnesium levels were measured at the same time pulmonary function tests were performed. ⋯ The functional vital capacity decreased from a baseline value of 3.37 +/- 0.49 to 3.19 +/- 0.73 L, and the forced expiratory volume at 1 second decreased from a baseline value of 2.61 +/- 0.58 to 2.36 +/- 0.68 L at 2 hours (P less than .05). The mean serum magnesium level was 1.7 +/- 0.2 mg/dL before the administration of the IV loading dose and 4.51 +/- 0.67 mg/dL 2 hours after initiation of the continuous infusion. Our results demonstrate a significant decrease in pulmonary function tests in term preeclamptic patients receiving magnesium sulfate for seizure prophylaxis.(ABSTRACT TRUNCATED AT 250 WORDS)