Obstetrics and gynecology
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Obstetrics and gynecology · Jan 1989
Disseminated intravascular coagulation and the syndrome of hemolysis, elevated liver enzymes, and low platelets in severe preeclampsia.
To clarify the role of disseminated intravascular coagulation (DIC) in women with the hemolysis, elevated liver enzymes, and low platelets (HELLP) syndrome, serial coagulation studies were performed prospectively in 18 patients. A semiquantitative DIC scoring system was used retrospectively to augment the diagnostic confidence of coagulopathy. At the time of admission to the hospital, three patients showed no evidence of DIC, eight had suspected DIC, and seven had manifest DIC. ⋯ Patients with manifest DIC at delivery developed significantly more life-threatening maternal complications than did patients with suspected DIC (P less than .02). Conservative management was not possible in any patients who were admitted with overt DIC because of deterioration of maternal and fetal status. Application of a sensitive DIC scoring system may be valuable in managing patients with the HELLP syndrome and selecting patients who may be treated expectantly.
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Obstetrics and gynecology · Sep 1988
ReviewGastrointestinal complications in gynecologic surgery: a review for the general gynecologist.
A working familiarity with the management of common perioperative gastrointestinal complications is required for all general gynecologists. Thermal gastrointestinal injury requires resection of the damaged portion of bowel unless the injury involves only the bowel serosa and is less than 0.5 cm in diameter. Small intraoperative lacerations of the intestine can be closed primarily, whereas larger lacerations often require resection. ⋯ Small-bowel obstruction, most likely to be caused by postoperative adhesions, can often be treated successfully by gastrointestinal intubation. Steps required in the initial management of an enterocutaneous fistula include institution of parenteral nutritional supplementation and antibiotics, skin protection, and investigative studies of the fistula. Preventive measures may be used at the time of any surgical procedure to reduce the incidence of many of these complications.
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Obstetrics and gynecology · Sep 1988
Review Historical ArticleThe conquest of cesarean section-related infections: a progress report.
More than a century ago, Robert P. Harris demonstrated convincingly that death from infection after cesarean section could be reduced significantly by operating early, rather than after several days of labor, by using aseptic surgical technique, and by closing the uterine incision. ⋯ These can be reduced by proper management of labor, by recognizing the need for cesarean section early, by using alternative methods for delivery when appropriate, by meticulous surgical technique, and by selective use of prophylactic antibiotics. These changes are not likely to occur unless care of obstetric patients is assumed by experienced obstetricians who are prepared to recognize and correct abnormal labor early and to perform instrumental extraction and vaginal breech deliveries rather than cesarean section in carefully selected patients.
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Obstetrics and gynecology · Sep 1988
Case ReportsPercutaneous balloon aortic valvuloplasty in pregnancy.
Severe symptomatic aortic stenosis in pregnancy carries a poor prognosis. Although cardiopulmonary bypass and surgical repair has been reported to have a low maternal mortality, the fetal risk remains substantial. ⋯ This allowed progression of the pregnancy to term and an uneventful delivery of a healthy infant, with no maternal complications. Although the long-term efficacy of percutaneous balloon aortic valvuloplasty has not been established, this case report has shown it to be useful as a palliative procedure.
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Obstetrics and gynecology · Sep 1988
Case ReportsFetal bradycardia associated with maternal hypothermia.
A case of fetal bradycardia associated with severe maternal hypothermia (92.9F) is reported. Until maternal temperature was corrected, the baseline fetal heart rate (FHR) remained between 90-110 beats per minute without other evidence of fetal distress and despite normal maternal blood pressure and pulse. ⋯ Upon return of maternal hypothermia, fetal bradycardia recurred, again responding only to rewarming. This evidence suggests that low maternal temperature alone may lead to alterations of FHR.