Obstetrics and gynecology
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Obstetrics and gynecology · May 1997
Comparative StudyAn increase of the plasma N-terminal peptide of proatrial natriuretic peptide in preeclampsia.
To determine whether increased concentrations of the N-terminal peptide of proatrial natriuretic peptide and of atrial natriuretic peptide are related to the severity of preeclampsia and gestational hypertension. ⋯ The levels of N-terminal peptide of proatrial natriuretic peptide were higher in women with preeclampsia than in those with gestational hypertension and higher in women with gestational hypertension than in those with normal pregnancies. A marked elevation in N-terminal peptide of proatrial natriuretic peptide may predict development of severe preeclampsia and/or an SGA infant.
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Although the clinical presentation and imaging techniques can raise suspicion for placenta previa percreta, this potentially catastrophic condition may remain undiagnosed or its extent underappreciated until delivery. The decision to proceed with definitive surgery in cases of placenta previa percreta should be carefully considered. ⋯ When possible, hysterectomy performed for placenta previa percreta is best avoided under anything other than ideal conditions. A multidisciplinary approach for preoperative, intraoperative, and postoperative management of placenta previa percreta optimizes maternal outcome.
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Obstetrics and gynecology · May 1997
Case ReportsUterine rupture during induction of labor at term with intravaginal misoprostol.
Misoprostol (prostaglandin E1) compares favorably with dinoprostone (prostaglandin E2) and oxytocin for labor induction at term. Excessive uterine activity has been reported using high-dose regimens, but no negative effect on outcomes has been observed. ⋯ Misoprostol can cause excessive uterine activity and uterine rupture.
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Obstetrics and gynecology · May 1997
Case ReportsOpioid-induced rigidity after intravenous fentanyl.
Large doses of intravenous opioids may cause severe rigidity and prevent spontaneous or controlled ventilation. The mechanism of this effect appears to be neuraxis dopamine antagonism. Rigidity after analgesic doses of fentanyl has not been reported previously. ⋯ Opioid administration may result in rigidity and respiratory embarrassment. Decreased analgesic requirements in pregnancy and concomitant butyrophenone administration may predispose to opioid-induced rigidity.