Obstetrics and gynecology
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Obstetrics and gynecology · Nov 2005
Case ReportsMassive pulmonary embolism in pregnancy treated with catheter fragmentation and local thrombolysis.
Catheter-directed thromboembolus fragmentation and thrombolysis is used with success for treatment of pulmonary embolism with hemodynamic decompensation in nonpregnant patients, but information on its use during pregnancy is limited. We report successful treatment of massive bilateral pulmonary emboli in the third trimester of pregnancy. ⋯ Catheter-directed mechanical fragmentation and local thrombolytic infusion therapy is a treatment option for pulmonary embolism with hemodynamic decompensation in pregnancy. Advantages are rapid clot lysis with consequent return of normal hemodynamics and uterine perfusion and avoidance of systemic thrombolytics and associated risk of bleeding complications.
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Obstetrics and gynecology · Nov 2005
Risk factors for spontaneous abortion in early symptomatic first-trimester pregnancies.
To evaluate the association of an ultimate diagnosis of miscarriage with various clinical symptoms and historical factors in a cohort of women presenting with pain, bleeding, or both in the first trimester of pregnancy. ⋯ II-2.
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Treatment of a major burn injury during pregnancy must incorporate modifications in management resulting from gestational physiologic changes. ⋯ Pregnancy-induced physiologic changes affect key factors in the management of the burned patient, including airway management and hemodynamic support. Multidisciplinary management is essential to achieve the best possible outcome.
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The obstetrician-gynecologist who provides expert witness testimony is recognized as an important participant in the medical liability system. He or she must define a standard of care and opine whether the standard has been breached and whether any perceived injury was caused by the breach. The American College of Obstetricians and Gynecologists (ACOG) ethical guidelines insist that the testimony be objective (free from intentioned distortion) and that the witness not assume an advocacy or partisan role. ⋯ Members of ACOG should be held to more restrictive ACOG guidelines and egregious testimony condemned by ACOG. Prospective peer review, increased judicial review, and testimony banks are other examples of methods to improve the quality of expert witness testimony. Alternatives to litigation for medical liability disputes and further tort reform might also make the system fairer and more sustainable.
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Obstetrics and gynecology · Nov 2005
Case ReportsLaparoscopic management of abdominal pelvic splenosis.
Splenosis is an unusual cause of pelvic pain. ⋯ Splenosis should be considered in patients with a history of splenic injury and abdominal pain. Laparoscopic excision of splenic nodules with the argon beam coagulator is a well-suited method of treatment for symptomatic splenosis.