Obstetrics and gynecology
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Intravenous magnesium sulfate tocolysis remains a North American anomaly. This therapy rose to prominence based on poor science and the recommendations of authorities. However, a Cochrane systematic review concluded that magnesium sulfate is ineffective as a tocolytic. ⋯ Given its lack of benefit, possible harms, and expense, magnesium sulfate should not be used for tocolysis. Any further use of magnesium sulfate for tocolysis should be restricted to formal clinical trials with approval by an institutional review board and signed informed consent for participants. Should tocolysis be desired, calcium channel blockers, such as nifedipine, seem preferable.
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Obstetrics and gynecology · Oct 2006
Practice GuidelineACOG Practice Bulletin: Clinical Management Guidelines for Obstetrician-Gynecologists Number 76, October 2006: postpartum hemorrhage.
Severe bleeding is the single most significant cause of maternal death world-wide. More than half of all maternal deaths occur within 24 hours of delivery, most commonly from excessive bleeding. It is estimated that worldwide, 140,000 women die of postpartum hemorrhage each year-one every 4 minutes (1). ⋯ All obstetric units and practitioners must have the facilities, personnel, and equipment in place to manage this emergency properly. Clinical drills to enhance the management of maternal hemorrhage have been recommended by the Joint Commission on Accreditation of Healthcare Organizations (2). The purpose of this bulletin is to review the etiology, evaluation, and management of postpartum hemorrhage.
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Obstetrics and gynecology · Oct 2006
Practice GuidelineACOG Committee Opinion: Number 345, October 2006: vulvodynia.
Vulvodynia is a complex disorder that can be difficult to treat. It is described by most patients as burning, stinging, irritation, or rawness. ⋯ No one treatment is effective for all patients. A number of measures can be taken to prevent irritation, and several medications can be used to treat the condition.