Clinical obstetrics and gynecology
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This chapter will report to the frequency of neonatal hypoxic-ischemic encephalopathy. The pathophysiology and the childhood outcome of encephalopathy due to hypoxia-ischemia will be examined. ⋯ Hypothermia seems to offer the most promise as a therapy for neuroprotection in hypoxic-ischemic encephalopathy. The evidence-based trials of hypothermia will be reviewed along with recommendations regarding clinical applications for this therapy and need for long-term follow-up of children receiving this therapy.
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Clin Obstet Gynecol · Sep 2007
Optimizing outcomes of surgery in advanced age--perioperative factors to consider.
The gynecologic surgeon should be knowledgeable about the normal physiologic changes associated with aging and skilled at assessing baseline medical comorbidities, neuropsychiatric, nutritional, social, and functional status as increasing numbers of older women seek and undergo surgical interventions to improve their quality of life. A multidisciplinary approach to the perioperative care of the older woman, aiming for prevention and early intervention, can help minimize both typical surgical complications and "geriatric" complications.
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Clin Obstet Gynecol · Sep 2007
ReviewHead cooling for neonatal encephalopathy: the state of the art.
The possibility that hypothermia started during or after resuscitation at birth might reduce brain damage and cerebral palsy has tantalized clinicians for a long time. The key insight was that transient severe hypoxia-ischemia can precipitate a complex biochemical cascade leading to delayed neuronal loss. There is now strong experimental and clinical evidence that mild to moderate cooling can interrupt this cascade, and improve the number of infants surviving without disability in the medium term. The key remaining issues are to finding better ways of identifying babies who are most likely to benefit, to define the optimal mode and conditions of hypothermia and to find ways to further improve the effectiveness of treatment.
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Clin Obstet Gynecol · Sep 2007
ReviewOn the mechanical aspects of shoulder dystocia and birth injury.
This article presents objective evidence about shoulder dystocia and its associated mechanical injuries, namely clavicle fractures, and brachial plexus injuries. Specifically, the review focuses on the mechanical response of the fetus to forces applied to it or its anatomic components, including possible force thresholds for injury. ⋯ Finally, the paper discusses the mechanical characteristics of maternal and fetal maneuvers for shoulder dystocia and demonstrates how shoulder dystocia models can be used to train clinicians in the performance of maneuvers that stress the fetus the least. From a mechanical point of view, there are obstetric methods and training that can be employed to reduce the stresses induced by the fetus while alleviating shoulder dystocia, thereby reducing, but not eliminating, the risk of mechanical injury.