Obstetrics and gynecology
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Obstetrics and gynecology · Dec 2011
Practice GuidelineCommittee Opinion no. 513: vaginal placement of synthetic mesh for pelvic organ prolapse.
Since 2004, use of synthetic mesh has increased in vaginal surgery for the treatment of pelvic organ prolapse. However, concerns exist about the safety and efficacy of transvaginally placed mesh. Based on the currently available limited data, although many patients undergoing mesh-augmented vaginal repairs heal well without problems, there seems to be a small but significant group of patients who experience permanent and life-altering sequelae, including pain and dyspareunia, from the use of vaginal mesh. The American College of Obstetricians and Gynecologists and the American Urogynecologic Society provide background information on the use of vaginally placed mesh for the treatment of pelvic organ prolapse and offer recommendations for practice.
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Obstetrics and gynecology · Dec 2011
Randomized Controlled TrialTransversus abdominis plane infiltration and quality of recovery after laparoscopic hysterectomy: a randomized controlled trial.
To examine the effect of a preoperative transversus abdominis plane infiltration on postoperative quality of recovery and analgesia in patients undergoing laparoscopic hysterectomy. ⋯ I.
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Obstetrics and gynecology · Dec 2011
Practice GuidelineCommittee Opinion no. 514: emergent therapy for acute-onset, severe hypertension with preeclampsia or eclampsia.
Acute-onset, persistent (lasting 15 minutes or more), severe systolic (greater than or equal to 160 mm Hg) or severe diastolic hypertension (greater than or equal to 110 mm Hg) or both in pregnant or postpartum women with preeclampsia or eclampsia constitutes a hypertensive emergency. Severe systolic hypertension may be the most important predictor of cerebral hemorrhage and infarction in these patients and if not treated expeditiously can result in maternal death. ⋯ Close maternal and fetal monitoring by the physician and nursing staff are advised. Order sets for the use of labetalol and hydralazine for the initial management of acute, severe hypertension in pregnant or postpartum women with preeclampsia or eclampsia have been developed.