Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Oct 2008
Case Reports[A woman in the second trimester of pregnancy with acute abdominal pain].
A 42-year-old pregnant (22 weeks) woman with a history of peptic ulcer 20 years earlier, was presented to our gynaecological clinic with acute abdominal pain in 2005. She was para-1, had delivered a healthy child two years earlier and now she had an uncomplicated pregnancy. Upon admittance she was pale, hyperventilating and complained of epigastric pain and nausea. ⋯ An interstitial pregnancy close to the ostium internum (cornual pregnancy) may have lead to the thinning and rupture of the uterine wall in the fundal part. Alternatively, the placenta's location in the upper uterine cavity (possibly caused by a 3 cm myoma that seemed to divide the uterine cavity into two compartments) may have caused thinning and rupture of the uterine wall in the fundal part. The literature describing uterine rupture in the second trimester is reviewed.
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Tidsskr. Nor. Laegeforen. · Oct 2008
[Do women with Caesarean section have to choose between pain relief and breastfeeding?].
The Caesarean section is a unique surgical procedure in that physicians postoperatively not only have to cater to the mothers' need for analgesics, but must also take into account the impact of this medication on the infant. Too cautious prescription of strong analgesics postoperatively may have untoward consequences, such as immobilisation and delayed onset of breastfeeding. ⋯ When the mother is most in need of opioid analgesics, lactation is barely established. Therefore, even if traces of opioids are absorbed into the mother's milk, the doses will be very small and the infant's oral bioavailability at this time is likely to be low. Consequently, there is little evidence to support a policy of overly restrictive use of opioids.