Canadian Medical Association journal
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This report describes two cases of severe cardiovascular collapse occurring during laparoscopy using carbon dioxide insufflation under general anesthesia. Both patients made eventual complete recovery. ⋯ A list of precautions for the safe conduct of laparoscopy is presented. Since these precautions have been followed there has been no recurrence of cardiovascular collapse in over 300 subsequent cases.
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Two cases of abruptio placentae with disseminated intravascular coagulation (DIC) were treated with heparin, and coagulation was monitored by thromboelastography as well as the usual hematology tests. The cases demonstrated the vagaries of DIC and both showed decreased overt hemorrhage after heparin treatment was started. Heparin may be indicated for the management of abruptio placentae where delivery is not imminent, where significant disseminated intravascular coagulation exists, and when adequate serial coagulation studies are available.
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Comparative Study
An analysis of maternal deaths in British Columbia: 1963 to 1970.
There were 132 maternal deaths in British Columbia in the years 1963 to 1970. The mean maternal mortality rate for these eight years was 0.317. Sixty of these deaths (45.5%) were due to direct obstetrical causes. ⋯ Hemorrhage continues to be a major problem, in particular among the native Indian women of the province. If further reduction in maternal mortality is to be achieved, obstetrical hemorrhage must be better managed and deaths due to abortions reduced. Future studies should reveal if the liberalized abortion laws will assist in the realization of the latter goal.