Obstetrics and gynecology
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Obstetrics and gynecology · Mar 1985
Preoperative crossmatch ordering and blood use in elective hysterectomy.
Preoperative crossmatch guidelines have been shown to improve crossmatch ordering practices. To refine crossmatch ordering, specific characteristics of 258 patients who underwent abdominal hysterectomy and 277 patients who underwent vaginal hysterectomy were correlated with blood transfusion by univariate and multivariate analyses. Abdominal hysterectomy patients with pelvic inflammatory disease with adhesions and/or abscess were significantly more likely to require blood transfusion. ⋯ Blood use was independently correlated with reduced preoperative hemoglobin and with estimated blood loss. Vaginal hysterectomy patients who had a colporrhaphy were more likely to require blood transfusion. Preoperative crossmatch recommendations made on the basis of these results reduce costs and increase the efficiency of predeposit autologous transfusion programs and preoperative crossmatch ordering practices.
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Since 1980 medical school faculty growth has essentially ceased, in comparison to earlier substantial increases. Women are represented in full-time faculty positions in a larger proportion than among practicing obstetrician-gynecologists. Subspecialist numbers on faculties have increased, with a small decline in generalist obstetrician-gynecologists. Despite the current plateau, medical school departments project a 36% increase in faculty members during the next five years, and an even larger increase in faculty involved in research.
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Obstetrics and gynecology · Dec 1984
Case ReportsPregnancy and acute optic disc edema of juvenile-onset diabetes.
Acute optic disc edema is a recently recognized, relatively benign manifestation of juvenile-onset diabetes mellitus. Twenty-three cases have been reported in the ophthalmology literature, two occurring during pregnancy. ⋯ The disorder manifests physical findings similar to those of papilledema, proliferative retinopathy with optic disc edema, inflammatory papillitis, and ischemic optic neuropathy, but has a benign course that requires no treatment and is not adversely affected by pregnancy. It is important to recognize this syndrome because failure to make the correct diagnosis in pregnancy may lead to inappropriate treatment, including therapeutic abortion.
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Twenty-three cases of major rupture of the pregnant uterus in which the life of the mother and/or fetus were endangered are presented. Fourteen cases (61.3%) resulted from rupture of a previous cesarean section scar. Rupture of an intact pregnant uterus in nine cases (38.7%) was related to oxytocic drug administration, obstetric manipulation, labor disorders, or external trauma. ⋯ Rupture of the intact uterus was characterized by increased blood loss and need for transfusion. When compared with rupture of the scarred uterus, however, operating times and mortality rates were similar. Fetal mortality was 35% (eight of 23) and there were no maternal deaths.
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Obstetrics and gynecology · Nov 1984
Epidural analgesia for planned vaginal delivery following previous cesarean section.
The effect of lumbar epidural on the course of labor, delivery, and outcome was studied in 115 parturients with a previous cesarean section who were given a trial of vaginal delivery. One hundred three women were multiparous and 12 were grandmultiparous. Uterine contractions and fetal heart rate (FHR) were monitored continuously in all patients. ⋯ Forty-eight women delivered spontaneously and 54 had an assisted second stage. Thirteen women delivered by a repeat low segmental cesarean section; dehiscence was observed in only one woman. Fetal outcome was satisfactory and similar to that of the authors' general parturient population.