Obstetrics and gynecology
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The Arnold-Chiari malformation type I is characterized by the prolapse of the cerebellar tonsils below the foramen magnum. There is a lack of literature on the management of a pregnancy in a woman affected by an Arnold-Chiari malformation. ⋯ Careful selection of anesthetic technique for the delivery of a woman with an Arnold-Chiari malformation is of paramount importance.
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Obstetrics and gynecology · Nov 2003
Case ReportsSevere hypernatremia after cesarean delivery secondary to transient diabetes insipidus of pregnancy.
Transient diabetes insipidus is an uncommon complication of pregnancy, usually manifesting with polydipsia and polyuria. This condition is considered to result from excess placental vasopressinase activity and is managed with deamino D arginine vasopressin. ⋯ Transient diabetes insipidus of pregnancy should be considered in the differential diagnosis of severe hypernatremia in obstetric patients with restricted oral intake after operative delivery.
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Obstetrics and gynecology · Nov 2003
Case ReportsAcute postpartum mental status change and coma caused by previously undiagnosed ornithine transcarbamylase deficiency.
Acute postpartum mental status change usually represents postpartum blues or depression. Psychosis and coma are rare. This is a case report of a patient with previously undiagnosed ornithine transcarbamylase deficiency presenting as postpartum acute mental status change and coma. ⋯ Ornithine transcarbamylase deficiency should be included in the differential diagnosis of acute postpartum coma. Hyperammonemia, hyperglutaminemia, and orotic aciduria are diagnostic, facilitate early treatment, and mitigate the risk of permanent neurologic impairment or death.
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Obstetrics and gynecology · Oct 2003
Intrapartum computerized fetal heart rate parameters and metabolic acidosis at birth.
To estimate to what extent computerized fetal heart rate (FHR) parameters are affected by labor and to estimate the relationship between FHR parameters and the degree of fetal metabolic acidosis in laboring patients at term. ⋯ In term pregnant women with reassuring FHR tracing, labor causes an increase in both short- and long-term FHR variation, which was abolished in the presence of nonreassuring FHR tracing. Computer-derived FHR parameters studied during the last hour of labor were not correlated with the degree of metabolic acidosis as measured in the umbilical artery at birth.
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Obstetrics and gynecology · Oct 2003
Changes in maternal characteristics and obstetric practice and recent increases in primary cesarean delivery.
To estimate the contribution of changes in maternal characteristics (namely, age, parity, prepregnancy weight, weight gain in pregnancy, smoking status) and obstetric practice (namely, labor induction, epidural anesthesia, delivery by an obstetrician, midpelvic forceps delivery) to recent increases in primary cesarean delivery rates. ⋯ Recent increases in primary cesarean delivery rates are a consequence of changes in maternal characteristics. Obstetric practice, which has altered due to changes in maternal characteristics and concerns related to fetal and maternal safety, has also contributed to increases in primary cesarean delivery.