Clinical obstetrics and gynecology
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Clin Obstet Gynecol · Jun 1998
Review Comparative StudyEpidural analgesia for labor: effect on the cesarean birth rate.
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Vaginal birth or trial of labor after previous cesarean delivery represents one of the most significant changes in obstetric practice. There are numerous reasons that influence the decision to proceed with either a trial of labor after previous cesarean delivery or elective repeat cesarean delivery. For the majority of women with a previous cesarean delivery, a trial of labor should be encouraged. ⋯ At present, however, there is no sufficiently predictive method to identify those women most likely to benefit from an elective repeat cesarean delivery. The management of labor in women with a previous uterine scar is not low risk. As the number of women who attempt vaginal birth after previous cesarean delivery increases, we should focus on trying to develop reliable methods of identifying women who should and should not undertake a trial of labor after cesarean delivery.
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The prevalence of hyperthyroidism in pregnancy is about 0.2%. The most common cause is Graves' disease. Maternal, fetal, and neonatal morbidity and mortality may be reduced to a minimum with careful attention to the clinical symptoms and interpretation of thyroid tests. ⋯ Surgery for the treatment of hyperthyroidism is reserved for the unusual patient who is allergic to both ATD; to those who have large goiters; to those who require large doses of ATD; or to those patients who poorly comply. Fetal and neonatal hyperthyroidism can be predicted in the majority of cases by the previous maternal medical and obstetric history and by the proper interpretation of thyroid tests. Finally, hyperthyroidism may recur in the postpartum period.