Obstetrics and gynecology
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Skillful administration of a well-chosen anesthetic can ease the birth process for the mother, and can possibly prevent such signs of stress in the fetus as bradycardia and asphyxia, which are caused by uterine vasoconstriction. The survey summarizes current knowledge of physiologic changes in pulmonary, cardiac, renal, and other functions during pregnancy and childbirth and the ways in which anesthesia may affect them. Indications and contraindications for the use of various types of anesthesia in normal and complicated deliveries are discussed, as are ways to prevent or minimize adverse reactions in mother and child. This summary facilitates the practicing obstetrician's understanding of the techniques, advantages, and problems involved with obstetric anesthesia and analgesia.
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The authors reviewed all documented cases of bacteremia in obstetric patients between 1975 and 1979, with emphasis on the clinical course. The incidence of bacteremia was 7.5:1000 obstetric admissions and 9.7% of those patients sampled. One hundred seventy-six bacteremic obstetric patients had the following diagnoses: endoparametritis (123), pyelonephritis (29), chorioamnionitis (14), and other (10). ⋯ The patients with chorioamnionitis had a fever index of 32.7 +/- 48.9F-hours and an average hospital stay of 4.8 +/- 2.3 days. These clinical measures are comparable with those in the general population with the same diagnoses at the authors' hospital. In this obstetric population, prompt, vigorous treatment rendered the clinical course of bacteremic patients with genital infections remarkably similar to that of nonbacteremic patients with the same kinds of infection.
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Obstetrics and gynecology · Oct 1981
Deaths from second trimester abortion by dilatation and evacuation: causes, prevention, facilities.
In 1978, dilatation and evacuation (D & E) became the leading method of abortion at 13 weeks' gestation or later in the United States. The increasing popularity of D & E reflects its relative advantages in safety, convenience, expense, and speed when compared with alternate methods. The authors reviewed all reported deaths from D & E in the United States between January 1, 1972, and December 31, 1978. ⋯ The advantage of D & E occurs largely in the 13- to 15-week gestation interval, that is, at the beginning of the second trimester. Policy makers should reconsider laws requiring all second trimester abortions to be performed in hospitals. Based on these data, 16 weeks' gestation would be more appropriate threshold at present.
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Obstetrics and gynecology · Sep 1981
Neonatal effect of prolonged anesthetic induction for cesarean section.
The relationship of induction-to-delivery and uterine incision-to-delivery intervals to neonatal outcome was studied in 105 parturient women undergoing cesarean section. Sixty patients received general anesthesia and 55 were given spinal anesthesia. During general anesthesia, induction-to-delivery intervals of more than 8 minutes and uterine incision-to-delivery intervals of more than 3 minutes were associated with significantly more instances of neonatal acidosis (umbilical artery pH 7.31 versus 7.22) and a greater incidence of low 1-min Apgar scores (4% versus 73%). In the groups receiving spinal anesthesia, prolongation of uterine incision-to-delivery interval by more than 3 minutes was found to be the only important factor influencing fetal outcome, as determined by an increased acidosis (umbilical artery pH 7.30 versus 7.18) and by depressed Apgar scores (0% versus 62%).
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Obstetrics and gynecology · Jun 1981
The effect of maternal administration of ephedrine on fetal heart rate and variability.
Ephedrine is the most popular vasopressor used in obstetrics to prevent or treat spinal or epidural hypotension. Fetal heart rate (FHR) changes during epidural anesthesia were studied in 71 patients; it was found that ephedrine administration (57 patients) was associated with significant increases in FHR and beat-to-beat variability. These changes were dose related and were not associated with fetal asphyxia as judged by measurement of fetal scalp blood pH or Apgar scores.