Clinical obstetrics and gynecology
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Women with cystic fibrosis (CF) are living to childbearing age and many have successful pregnancies. Preconception care with optimization of pulmonary function, eradication of pulmonary infection, improved nutritional status, and diabetes care improve fertility and pregnancy outcome. ⋯ Individuals with CF and end stage lung disease have improved survival after lung transplant. Women with lung transplants can have successful pregnancy, but the risk of organ rejection and death are high.
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Amniotic fluid embolism (AFE) remains an enigmatic, but devastating obstetrical condition associated with significant maternal and newborn morbidity and mortality. Although our understanding of this condition is incomplete, research over the past 2 decades has altered traditional concepts of both the causation and pathophysiology of AFE. Although maternal treatment remains primarily supportive, prompt delivery of the fetus can substantially improve neonatal outcome after AFE-induced cardiac arrest. Newer biochemical markers may in the future enhance the specificity and sensitivity of this clinical diagnosis and could potentially lead to improved therapy.
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The maternal respiratory tract undergoes significant anatomic and physiologic changes during pregnancy, which increase maternal susceptibility to respiratory failure. Respiratory failure in pregnancy is relatively rare, but it remains one of the leading conditions requiring intensive care unit admission in pregnancy and carries a high risk of maternal and fetal morbidity and mortality. ⋯ Treatment goals during respiratory failure in the pregnant woman are similar to those outside of pregnancy-to maintain adequate ventilation and to provide hemodynamic and nutritional support. Additionally, the obstetrician will need to monitor fetal status and help to determine the best timing for delivery.
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Endometriosis has been associated with pain and infertility. The gold standard for the diagnosis of endometriosis has been visual inspection by laparoscopy, preferably with histologic confirmation. ⋯ No serum marker has been found to diagnose endometriosis with adequate sensitivity and specificity. There has been a recent focus on the presence of nerve fibers in the eutopic endometrium of patients with endometriosis.