Obstetrics and gynecology
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Obstetrics and gynecology · Apr 1990
The demise of vaginal operative obstetrics: a suggested plan for its revival.
Predictions made more than a quarter of a century ago regarding excessive use of cesarean delivery for cases of dystocia have been realized. Breech presentation, correctable dystocia, and twin gestation are increasingly being delivered by the abdominal route. Recent studies have shown that neonatal morbidity is not inherently improved by cesarean birth, and in fact have reported comparable results with vaginal operative procedures in properly selected and managed cases. ⋯ The reintroduction of vaginal operative procedures to modern obstetrics would help reduce the cesarean birth rate. However, major changes in the medical liability system, medical education and training, and the method of certifying obstetricians will be required before vaginal operative obstetrics becomes a serious alternative to cesarean delivery. Without these changes, I believe there is little hope of reversing the trend toward cesarean birth.
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Obstetrics and gynecology · Mar 1990
ReviewNonimmune hydrops fetalis associated with genetic abnormalities.
The purpose of this review of the literature on nonimmune hydrops fetalis was to evaluate whether recent clinicopathologic studies have modified the relative incidence of the different associated conditions and the management of these pregnancies. We found 600 cases of nonimmune hydrops fetalis published since 1982. These cases were reviewed with particular attention to genetic causes and were compared with a literature review of 298 cases published before 1982. ⋯ The most frequently identified genetic abnormalities in our review were chromosomal disorders (15.7%), alpha-thalassemia (10.3%), skeletal dysplasia (4%), arthrogryposis multiplex syndromes (1.8%), multiple pterygium syndrome (1.5%), and lysosomal storage disorders (1.0%). These results confirm the need for systematic chromosome analysis in fetuses with nonimmune hydrops. From this review, we conclude that prenatal noninvasive and invasive techniques combined with detailed pathologic studies have improved the accuracy of diagnosis of the underlying causes of nonimmune hydrops fetalis and have influenced the management of these pregnancies.
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Obstetrics and gynecology · Mar 1990
The Jarisch-Herxheimer reaction complicating syphilotherapy in pregnancy.
Thirty-three gravidas with syphilis were monitored with hourly vital signs and examinations for 24 hours after treatment with benzathine penicillin G. Fifteen (45%) of the subjects had a Jarisch-Herxheimer reaction, including all three, 12 of 20 (60%), and none of ten of those with primary, secondary, and latent syphilis, respectively. The most common symptoms were fever (73%), uterine contractions (67%), and decreased fetal movement (67%). ⋯ Prostaglandin F2 alpha and prostacyclin metabolites were elevated transiently in the one subject studied, suggesting their role in mediating the cardiovascular and uterine events in the post-treatment period. The Jarisch-Herxheimer reaction in pregnancy is similar in frequency, character, and intensity to that in nonpregnant adults, but gravidas may have increase uterine activity and transient alterations in fetal well-being. The pregnant patient with a severely affected fetus with congenital syphilis may experience preterm labor, preterm delivery, or fetal death in association with the Jarisch-Herxheimer reaction.
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Obstetrics and gynecology · Dec 1989
Randomized Controlled Trial Comparative Study Clinical TrialPulsatile administration of oxytocin for augmentation of labor.
In a randomized study, 94 patients with term pregnancies underwent augmentation of labor with either continuous or pulsed (every 8 minutes) intravenous oxytocin infusion. There were no significant differences with respect to the maternal characteristics, cervical dilatation and effacement, induction-to-labor interval, induction-to-delivery interval, cesarean section rate, analgesia for labor, or low Apgar scores. No hyperstimulation was noted in either group. ⋯ The mean +/- SEM oxytocin administered in the pulsed-infusion group was significantly lower than that in the continuous-infusion group (2.1 +/- 0.4 versus 4.1 +/- 0.4 mU/minute; P less than .001). The mean +/- SEM total amount of oxytocin administered was 1300 +/- 332 mU for the pulsed group and 1803 +/- 302 mU for the continuous group, indicating that lower amounts of oxytocin were required for pulsed administration. Our study demonstrates that pulsatile administration of oxytocin is similar in efficacy to our standard continuous oxytocin infusion and requires a lower total amount and rate of oxytocin administered, which may afford a greater margin of safety.
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Obstetrics and gynecology · Dec 1989
Survival and morbidity of extremely premature infants based on obstetric assessment of gestational age.
To provide current clinical information for obstetric decision-making and perinatal management, we present early morbidity and mortality data for extremely premature infants based on obstetric assessment of gestational age. We reviewed the records of 141 live-born infants with birth weights of 1600 g or lower born at a university hospital level III neonatal intensive care unit between January 1986 and April 1988, whose gestational ages estimated by antenatal obstetric evaluation were between 24-29 completed weeks. ⋯ Rates of severe intraventricular hemorrhage (grade 3 or 4) ranged from 100% at 24 weeks to 7% at 29 weeks. These data represent a significant increase in survival and a decrease in early morbidity compared with those form similar populations before 1986.