Obstetrics and gynecology
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Obstetrics and gynecology · Feb 2007
Case ReportsRecombinant factor VIIa to successfully manage disseminated intravascular coagulation from amniotic fluid embolism.
Amniotic fluid embolism (AFE) is a rare syndrome that can complicate pregnancy and labor. It often has debilitating and lethal consequences. One serious sequela of AFE is disseminated intravascular coagulation (DIC). ⋯ The use of recombinant activated factor VIIa in cases of massive hemorrhage, such as in our patient, is controversial but has been shown, in some cases, to reverse DIC and be successful. The use of recombinant activated factor VIIa should be considered in patients with massive obstetric hemorrhage in whom standard measures of stabilization are unsuccessful.
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Obstetrics and gynecology · Feb 2007
Case ReportsSheared epidural catheter during an elective procedure.
Epidural catheter fracture and retention is uncommon. Imaging techniques identifying catheter location are limited, and clear management guidelines are lacking. Radiculopathy and lumbar stenosis are recognized complications. ⋯ Retained epidural catheter fragments can be associated with long-term sequelae. Immediate removal is facilitated by a blood-clot tract and may present the best time for removal. Current imaging techniques have limited use in these situations.
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Obstetrics and gynecology · Feb 2007
Effects of an educational workshop on performance of fourth-degree perineal laceration repair.
To develop a valid and reliable tool to objectively measure surgical skill necessary for repair of fourth-degree perineal lacerations and then to use this tool to measure improvement after a workshop. ⋯ II.
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Maternal pregravid obesity is a significant risk factor for adverse outcomes during pregnancy. In early pregnancy there is an increased risk of spontaneous abortion and congenital anomalies. In later gestation maternal metabolic manifestations of the metabolic syndrome, such as gestational hypertensive disorders and diabetes, become clinically recognized because of the increased insulin resistance in obese compared with nonobese women. ⋯ Although preliminary results of bariatric surgery are encouraging, the procedure is expensive and not for all obese women, and we recognize that long-term follow-up data on offspring of obese women who have undergone bariatric surgery before pregnancy are lacking. In the interim, we need to encourage obese women to lose weight before conception, using lifestyle changes if possible. During pregnancy, weight gain should be limited to Institute of Medicine guidelines (currently under review) and encouragement given for physical activity.
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Nemaline myopathy is a rare, slowly progressive neuromuscular disorder, characterized by generalized skeletal and smooth muscle weakness and hypotonia. It is extremely rare in pregnancy. However, it may adversely affect pregnancy, and pregnancy may exacerbate the natural progress of the condition. ⋯ It is important that the clinician has a clear understanding of the clinical spectrum of nemaline myopathy, the available methods for perinatal diagnosis, and optimal antenatal care. A multidisciplinary team approach is emphasized, with specific reference to the method of analgesia and anesthesia during labor and route of delivery.