Obstetrics and gynecology
-
Obstetrics and gynecology · Oct 1994
Review Case ReportsGiant uterine fibromyoma producing secondary polycythemia.
Although the association between large uterine fibromyomas and secondary polycythemia has been described previously, the mechanism has not been elucidated definitively. Investigators have measured erythropoietin levels in fibromyomas to determine whether these tumors are causing the polycythemia by erythropoietin overproduction; however, these studies were performed before the availability of recombinant erythropoietin assays. ⋯ This case provides evidence for three of the postulated mechanisms by which uterine fibromyomas may cause polycythemia. First, the patient was hypoxic, suggesting shunting within the tumor. Second, the leiomyoma was compressing the ureters, so the kidneys may have been inappropriately producing excess erythropoietin. Third, the tumor itself may have been producing the erythropoietin. In any case, the erythropoietin level in this patient was inappropriately high, providing useful evidence that her polycythemia was secondary to her fibromyoma.
-
Obstetrics and gynecology · Oct 1994
Comparative StudyFactors associated with the use of intrapartum epidural analgesia.
To evaluate the influence of socioeconomic factors and provider characteristics on the use of intrapartum epidural anesthesia. ⋯ Use of intrapartum epidural analgesia varies considerably among sites and is associated with nulliparity, higher maternal age, and several nonclinical factors.
-
Obstetrics and gynecology · Oct 1994
Case ReportsRuptured pelvic appendix diagnosed by transvaginal sonography.
Appendicitis in a pelvic appendix can be difficult to diagnose. Transvaginal sonography may help to visualize an inflamed pelvic appendix. ⋯ To our knowledge, this is the first case of appendicitis diagnosed with transvaginal sonography. Transvaginal sonography can delineate the features of an inflamed pelvic appendix and help to narrow the diagnostic possibilities in symptomatic women of childbearing age.