Obstetrics and gynecology
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Obstetrics and gynecology · Jul 1978
Case ReportsAmniotic fluid embolism and disseminated intravascular coagulation after evacuation of missed abortion.
The combination of amniotic fluid embolism and disseminated intravascular coagulation in obstetrics usually occurs at term associated with tumultuous labor. Maternal death almost inevitably follows. ⋯ Prompt recognition and aggressive appropriate therapy were responsible for patient survival with virtually no residual sequelae. Diagnosis was established on the basis of serial chest x-rays, pulmonary function tests, sputum, and serial blood studies.
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Obstetrics and gynecology · Jun 1978
Human chorionic gonadotropin (beta-subunit) in the early diagnosis of ectopic pregnancy.
In 15 women with suspected ectopic pregnancy considerable amounts of beta-subunit of human chorionic gonadotropin (hCG) were detected in the serum by the radioimmunoassay technique. The diagnosis was proved by laparotomy. ⋯ The detection of the beta-subunit of hCG in the serum was found to be an excellent tool for the early diagnosis of ectopic pregnancy, thus helping to prevent the dangerous sequelae which follow in the late diagnosis of this condition. The advantage of detecting the beta-subunit of hCG rather than hCG is discussed.
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Growing interest in the emergence of subspecialties within obstetrics and gynecology prompted a survey of all Junior Fellows of the ACOG. That survey, representing the attitudes and expectations of 1702 housestaff and practitioners, disclosed that nearly 31% of obstetric-gynecologic residents planned to subspecialize as contrasted to 19.5% of postresidency obstetrician-gynecologists who either engaged in or plan to engage in subspecialty training/practice. ⋯ There was, in addition, a general feeling that subspecialists should confine their activities to major medical centers, and an unfavorable attitude was expressed toward subspecialty-board-imposed practice restrictions. Details regarding the factors influencing Junior Fellows' response to subspecialization are discussed.
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A new rapid method of presurgical cleansing of the hands has been evaluated in a clinical setting. The effectiveness of a 90 second jet wash has been compared with a standard 10-minute presurgical scrub. ⋯ The results showed that the 90-second jet wash was more effective in degerming the hands than the 10-minute standard brush scrub. Other advantages of the new method, such as the amount of time saved, the standardization of cleansing, and reduced skin irritation are discussed.
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In 13 patients, episodes of transient fetal cardiac arrest were observed in a group of 594 extensively monitored labors during a given 3-year period. The number of episodes per patient ranged from one to six, with a maximal duration of cardiac arrest (R-R interval) being 5.2 seconds. All of the patients responded to changing maternal position or termination of pregnancy except 1. ⋯ Cardiac arrest is though to be an extensive form of severe variable deceleration. The hypothesis is made that these fetuses had an unbalanced autonomic nervous system and/or an overwhelming vagal tone. If these signs are detected early by fetal monitoring, attention should be paid to the possibility of cardiac arrest.