Obstetrics and gynecology
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In an effort to determine if a changing clinical picture for placenta accreta exists in the late 1970s, 22 cases from January 1, 1975, to May 30, 1979, at Los Angeles County/University of Southern California (LAC/USC) Medical Center were reviewed. An incidence of clinically diagnosed placenta accreta of 1 per 2562 deliveries for all cases and 1 per 4027 for pathologically confirmed cases (ie, hysterectomy specimens) was found. Mean age of the patients was 29.5 years, and mean gravidity, parity, and abortion were 3.4, 2, and 0.27, respectively. ⋯ Hysterectomy was performed on 14 patients, and conservative measures were employed in 8 patients. One maternal death (4.5%) occurred, but there was no perinatal mortality. The clinical picture of placenta accreta today is one of higher reported incidence, lower parity, greater incidence of associated placenta previa, individualized management, and decreasing maternal and perinatal mortality.
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Obstetrics and gynecology · Jul 1980
Case ReportsDysgerminoma of the ovary associated with true hermaphroditism.
A dysgerminoma of the left gonad exhibiting malignant features was diagnosed at laparotomy in a 33-year-old virginal phenotypic female who had a normal menstrual history. Pathologic examination of the contralateral (right) gonad revealed an ovotestis. The nonaffected residual portion of the tumor-bearing left gonad exhibited only ovarian stroma. ⋯ The findings are indicative of true hermaphroditism. The occurrence of dysgerminoma and other tumors in association with various forms of gonadl dysgenesis is discussed. To the authors' knowledge, this is the first reported case of dysgerminoma occurring in a phenotypic female hermaphrodite.
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Obstetrics and gynecology · Jun 1980
Ineffectiveness of povidone-iodine irrigation of abdominal incisions.
Two to four percent of uncontaminated surgical wounds become infected; the incidence is increased in contaminated cases. The present study was designed to determine the efficacy of wound irrigation with povidone-iodine in patients not receiving prophylactic antibiotics who were undergoing gynecologic operations. The results revealed no significant difference in the relatively high occurrence of wound infections, morbidity, and elevated fever indices between the povidone-iodine wound irrigation group of patients and the control group. From a review of previous studies of topical antibiotics and antiseptics in contaminated cases as well as from the present findings, providone-iodine wound irrigation without assocaited use of prophylactic antibiotics does not appear to reduce significantly the incidence of wound infections in patients with potential vaginal contamination.
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Obstetrics and gynecology · May 1980
Case ReportsIntramyometrial prostaglandin F2 alpha in the treatment of severe postpartum hemorrhage.
Three patients with severe postpartum hemorrhage due to uterine atony were treated with intramyometrial injection of 1 mg of prostaglandin F2 alpha with excellent results. This was an effective, safe, and rapid therapy in these cases of severe postpartum bleeding.
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Suction curettage is the procedure of choice for first trimester abortion. The basic preevaluation and follow-up standards for this operation have been adopted by most physicians. In some instances, however, follow-up assessment may be inadequate, particularly regarding the histopathologic evaluation of uterine contents. ⋯ Ultrasonography and endoscopic methods such as laparoscopy and hysteroscopy are invaluable in locating the site of the pregnancy and in preventing serious sequelae. The authors report the outcome of 25 women in whom abortion by suction curettage failed. A protocol outlining the methods used for diagnosis and therapeutic management is presented.