Obstetrics and gynecology
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Obstetrics and gynecology · Feb 1979
Case ReportsAlpha blockade and surgical intervention of pheochromocytoma in pregnancy.
The antepartum diagnosis of pheochromocytoma concurrent with pregnancy has been reported in 42 cases. These cases were analyzed for the effect of preoperative alpha blockade and of the timing of surgical intervention. Alpha blockade, when performed promptly in all pregnant patients in whom the diagnosis of pheochromocytoma was made, reduced fetal mortality regardless of the gestational age. ⋯ If the tumor could not be located during a combined procedure, delivery followed by delayed resection was not associated with any greater maternal mortality. The surgical approach required for patients diagnosed in the first or second trimester was less clear. Although alpha blockade is indicated in such early patients, it cannot yet be determined if a delay in the tumor excision will subject the mother and fetus to a greater risk than the accepted practice of early resection with delayed delivery.
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Obstetrics and gynecology · Jan 1979
Case ReportsSubarachnoid hemorrhage secondary to ruptured cerebral aneurysm in pregnancy.
Eight patients suffering ruptured cerebral aneurysms during pregnancy were managed at the University of Western Ontario hospitals between 1967 and 1977. Seven aneurysms were managed surgically. All of these patients survived, 1 with permanent neurologic deficit. ⋯ The prognosis for ruptured cerebral aneurysms during pregnancy is good for both mother and fetus. A short course of conservative therapy followed by surgical management of the aneurysm is advocated. Delivery may be managed according to obstetrical indications following surgical correction of the aneurysm.
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Sixty-six premature breech deliveries were studied retrospectively. Forty-eight patients were permitted a trial of labor, 47 of whom ultimately delivered vaginally. ⋯ When Apgar scores, perinatal mortality rates, cord prolapse, and entrapment of the aftercoming head are considered, cesarean section is probably the safer course of management for the patient with a footling breech infant, especially when the infant weighs 1500 g or less. However, the data indicate that a trial of labor can be safely undertaken in the presence of a premature frank or complete breech presentation.
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Obstetrics and gynecology · Nov 1978
Clinical Trial Controlled Clinical TrialNaproxen sodium in dysmenorrhea. Its influence in allowing continuation of work/school activities.
Sixty-four women with primary dysmenorrhea participated in a double-blind, parallel trial of maproxen sodium versus placebo during three menstrual cycles. Comparative measures employed to assess the efficacy of the medications included changes in pain intensity during each dysmenorrheic episode, the degree of pain relief afforded, the necessity of using a supplementary analgesic, and the extent to which medication enabled the patients to continue their daily activities unimpeded. ⋯ Particularly striking was the fact that of 22 naproxen sodium treated women who historically had to stay at home from work and/or in bed, only 5 remained incapacitated compared with 21 of 26 patients of the placebo group. Only 1 patient experienced side effects (nausea and hypomenorrhea) from naproxen sodium.
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Obstetrics and gynecology · Oct 1978
World Health Organization studies of prostaglandins versus saline as abortifacients. A reappraisal.
The World Health Organization (WHO) Task Force on the Use of Prostaglandins for the Regulation of Fertility has sponsored a series of randomized clinical trials and case-series investigations to assess the effectiveness and safety of prostaglandins as abortifacients. Our reanalysis of the WHO studies found the prostaglandins to be faster and more hazardour than hypertonic saline as intraamniotic abortifacients. ⋯ For gestations of greater than or equal to 17 weeks, the occurrence of live births in prostaglandin-induced abortions has produced serious legal and ethical problems in the United States. Until the effectiveness and safety of other prostaglandins regimen approach that of D&E, we feel that D&E should be the index of comparison against which newer methods of inducing abortion are tested.