Obstetrics and gynecology
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To review reports of the supine hypotensive syndrome with reference to clinical presentation, suggestions on the mechanism of onset, and the possibility of advance detection. ⋯ Supine hypotensive syndrome is characterized by severe supine symptoms and hypotension in late pregnancy, which compel the unconstrained subject to change position. Rarely, it may manifest even from the fifth month of pregnancy or postpartum, as well as in the pelvic tilt or sitting positions. Although inferior vena cava compression, influenced primarily by the size of the uterus and exact maternal and fetal position, is the major determinant in its development, other factors may also be important in modulating the circulatory effects of such compression. Advance recognition of susceptibility to the syndrome depends on a history of severe supine symptoms or supine intolerance and an increase in maternal heart rate and decrease in pulse pressure in the supine position. As there seems to be a spectrum of severity from minimal central cardiovascular alterations to severe syncopal shock resulting from supine inferior vena cava compression, it is difficult to define a cutoff point at which the syndrome occurs. Although usually recognizable by maternal symptoms, severe hypotension without symptoms has been reported on three occasions.
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Obstetrics and gynecology · May 1994
Comparative StudyA comparison of cardiac index in normal term pregnancy using thoracic electrical bio-impedance and oxygen extraction (Fick) techniques.
To correlate cardiac index in normal late third-trimester pregnancy using the thoracic electrical bio-impedance technique with that obtained from the oxygen extraction technique. ⋯ Thoracic electrical bio-impedance cardiac index assessment is influenced by maternal position and must be used with caution in clinical research protocols. This technique appears to be inappropriate for general clinical use during pregnancy.
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Obstetrics and gynecology · May 1994
Case ReportsLatrodectus mactans (black widow spider) envenomation: an unusual cause for abdominal pain in pregnancy.
The differential diagnosis of abdominal pain in pregnancy is extensive. An important consideration in endemic areas is a bite by a black widow spider. ⋯ In endemic areas, black widow spider envenomation should be part of the differential diagnosis of abdominal pain in pregnancy.
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Obstetrics and gynecology · May 1994
Case ReportsAcute promyelocytic leukemia in pregnancy: all-trans retinoic acid as a newer therapeutic option.
Acute promyelocytic leukemia is a unique subset of acute myelogenous leukemia, characterized by a neoplastic proliferation of promyelocytes and a prompt response to all-trans retinoic acid (tretinoin), which induces differentiation of immature leukemic promyelocytes into mature neutrophils. Because of the high incidence of disseminated intravascular coagulation (DIC) associated with acute promyelocytic leukemia and the danger of exacerbation of DIC with pregnancy, management of acute promyelocytic leukemia during pregnancy requires prompt and careful attention. ⋯ If the fetus can be delivered safely, tretinoin as a single agent is an option for the initial treatment of maternal acute promyelocytic leukemia because it does not suppress the bone marrow and may ameliorate DIC. Because of the danger of hyperleukocytosis, chemotherapy should be added initially if the white blood cell count is greater than 5000/microL. If the fetus cannot be delivered at a viable stage, conventional cytotoxic chemotherapy is the alternative option.