Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC
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J Obstet Gynaecol Can · Dec 2004
Comparative StudyEvaluation of postoperative pain control for women undergoing surgery for gynaecologic malignancies.
(1) To compare the benefits of epidural analgesia and patient-controlled analgesia (PCA) in the management of postoperative pain in women with gynaecologic malignancies,and (2) to understand issues related to the delivery of pain control strategies. ⋯ Postoperative pain management was excellent both in women who received PCA and in those who received epidural analgesia. Problems related to the delivery of pain control were more common in the epidural group.
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J Obstet Gynaecol Can · Dec 2004
The influence of hospital closures in Nova Scotia on perinatal outcomes.
To evaluate the effect of hospital closures on critical obstetrical interventions and perinatal outcomes in rural communities in Nova Scotia, Canada. ⋯ Although trends over time demonstrated some regional differences in obstetrical interventions and perinatal outcomes, our retrospective evaluation did not reveal a consistent relationship between reductions in maternity services associated with hospital closures and systematic, population-level adverse perinatal consequences in Nova Scotia.
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To help direct the organized and effective implementation of uterine fibroid embolization into clinical practice in Canada. ⋯ 1. Women considering treatment of fibroids should be counselled that while the early results of uterine artery embolization are encouraging, no long-term data exist. (II-2-B) 2. UFE should only be considered for women with symptomatic or problematic fibroids who might otherwise be advised to have surgical treatment. (III-A) 3. UFE as a treatment for fibroids in patients wishing to preserve their fertility should be undertaken with full disclosure to the patient about the limitations of such a procedure and the lack of existing data regarding future fertility and pregnancy outcomes. (III-C) 4. UFE is contraindicated in women who have evidence of current genitourinary infection and/or malignancy. (II-2-B) 5. Women who choose UFE as an alternative to hysterectomy should be counselled regarding the risk of major complications f UFE where hysterectomy may be urgently required and potentially lifesaving. In view of this small but important risk, UFE is relatively contraindicated in women who are unwilling to have a hysterectomy under any circumstances. (III-C) 6. Genitourinary infection is the predominant cause of serious morbidity and mortality. Further research on the utility of prophylactic antibiotic therapy and the value of pretreatment screening for infection is needed. (II-2-B) 7. A gynaecologist who is familiar with UFE should evaluate all patients considered for UFE before the procedure is booked and a consensus on the suitability of the procedure achieved between the gynaecologist and radiologist. (III-C) 8. Only radiologists with specialized embolization experience and techniques should perform UFE. (III-C) 9. The particular responsibilities of both gynaecologist and radiologist should be established prior to treatment and be set out in a relevant hospital protocol. A particular physician must be responsible for the patient at all times. (III-C) 10. A Canadian national registry of numbers, indications, outcomes, complications, and successful pregnancies associated with UFE should be created and jointly administered and funded by the SOGC, CAR, and CIRA. (III-C).
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J Obstet Gynaecol Can · Sep 2004
Surgical management of severe obstetric hemorrhage: experience with an obstetric hemorrhage equipment tray.
Hemorrhage remains a leading cause of severe maternal morbidity and death. In addition to the appropriate use of oxytocic agents for uterine atony, surgical techniques, including uterine tamponade, major vessel ligation, compression sutures, and hysterectomy, may be required. On the rare occasions they are needed, the instruments and equipment required for these surgical techniques may not be readily available. ⋯ The ready availability of an obstetric hemorrhage equipment tray on the labour ward facilitates prompt surgical management of severe obstetric hemorrhage, and may reduce the need for blood transfusion and hysterectomy.
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J Obstet Gynaecol Can · Aug 2004
Recent trends in caesarean delivery rates and indications for caesarean delivery in Canada.
To examine recent trends in Caesarean delivery rates as well as the indications for Caesarean delivery in Canada, excluding the provinces of Manitoba and Quebec. ⋯ Most of the recent increase in Caesarean delivery rates in Canada was attributed to increases in primary Caesarean delivery for dystocia and elective repeat Caesarean deliveries.