Obstetrics and gynecology
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Approximately half of the more than 500,000 preterm births each year result from preterm labor. Tocolytic therapy continues to be the focus of treatment of these women. Although a variety of tocolytics are used in clinical practice, magnesium sulfate remains one of the most commonly used agents. ⋯ If initiated to achieve time for antenatal corticosteroid administration, or for other acute reasons, treatment can be discontinued once these goals have been achieved or if labor subsides before then. Because brief pregnancy prolongation is unlikely to improve newborn outcomes after corticosteroid administration has been completed, it is appropriate to withhold magnesium sulfate tocolysis from women with recurrent preterm labor thereafter. If magnesium sulfate is given for neuroprotection, a protocol from one of the three major trials that have demonstrated benefits should be used.
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Obstetrics and gynecology · Sep 2009
Randomized Controlled TrialIntravenous nitroglycerin for external cephalic version: a randomized controlled trial.
To estimate whether treatment with intravenous nitroglycerin for uterine relaxation increases the chance of successful external cephalic version. ⋯ I.
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Obstetrics and gynecology · Sep 2009
Antimicrobial prophylaxis for cesarean delivery before skin incision.
To estimate the effect of a hospital-wide change in the timing of antimicrobial prophylaxis in cesarean deliveries on maternal and neonatal infections. ⋯ II.
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Obstetrics and gynecology · Sep 2009
Review Meta AnalysisThe effect of early oxytocin augmentation in labor: a meta-analysis.
To estimate the effects of early augmentation with oxytocin for slow progress of labor on the delivery method and on indicators of maternal and neonatal morbidity. ⋯ Early oxytocin for augmentation in labor is associated with an increase in spontaneous vaginal delivery.
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Obstetrics and gynecology · Sep 2009
ReviewVon Willebrand disease: key points from the 2008 National Heart, Lung, and Blood Institute guidelines.
Von Willebrand disease (VWD) is the most common inherited bleeding disorder and may affect as many as one in 100 women. The condition results from a deficiency, dysfunction, or absence of von Willebrand factor (VWF). In women, the most common symptom of VWD is menorrhagia. Of women with menorrhagia, 5-20% have been found to have previously undiagnosed VWD. Besides menorrhagia, women with VWD are more likely to experience other conditions that manifest with abnormal reproductive tract bleeding. The patient with a suspected bleeding disorder should be referred to a hemophilia treatment center or hematologist with expertise in bleeding disorders for definitive diagnosis. After diagnosis, the first choice of therapy for the management of menorrhagia in adolescents or adult females who do not desire child bearing is still hormonal contraceptives. Women who fail hormonal contraceptives, yet desire future child bearing, and women who desire pregnancy are candidates for hemostatic therapy, which is generally reserved for patients with VWF levels less than 50 international units/dL. During pregnancy, VWF levels rise, frequently obviating the need for hemostatic therapy at the time of delivery. Minor procedures can be managed with 1-desamino-8-D-arginine vasopressin, antifibrinolytic medication, or both, but major surgery or childbirth requires replacement with VWF and should be conducted in a center with available hematologists, anesthesiologists, pharmacists, and laboratory support experienced in the management of bleeding disorders. ⋯ III.