Zentralblatt für Gynäkologie
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We show by two case reports, that the HELLP-syndrome is the most severe form of pre-eclampsia and associated with a relative high maternal and perinatal mortality because of the sudden onset of the complications. In the first case report we describe the development of this syndrome after two eclamptical convulsions on the 6th day of puerperal period. ⋯ We want to show, that caesarean section cannot avoid this complication. It is not in all cases the most advantageous procedure of delivery in patients with HELLP-syndrome.
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Urapidil is an antagonist of postsynaptic alpha 1 receptors, which leads to a diminution of the increased blood pressure by reducing the peripheral vascular resistance. With this pilot study we examined, whether it is possible to reduce the pregnancy-induced-hypertension with urapidil postpartum. ⋯ We observed a declining blood pressure in all cases without any tachycardia or serious side effects. Further studies will have to classify the rank of urapidil in the treatment of hypertension in preeclampsia.
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Survey about oral contraceptives and postmenopausal hormonal replacement therapy and the effects on coagulation system. The question to withdraw oral contraceptives 4 weeks before a gynecological operation cannot be answered sufficiently. ⋯ It can be anticipated, that this rule will be changed in future. There are no scientific hints, which could bring a phlebitis or varicosis in connection etiologically with a thromboembolic disorder during oral contraceptives.
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The availability of adequate endoscopic instruments has led to an increased interest in hysteroscopic surgical procedures. An electrolyte-free irrigation fluid is essential for the distention of the uterine cavity, with acceptable uterine distention occurring at 80-150 mmHg. The HSK syndrome, the intravascular absorption of a hypotonic irrigation fluid with subsequent hypotonic hyperhydration with hyponatremia, has to be considered as a risk during hysteroscopic procedures. ⋯ The duration of the hysteroscopic procedure should be limited to 60 min. Addition of ethanol to the irrigating fluid may be suitable for early detection of fluid absorption. However, commercial solutions are not yet available.
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The Inversio uteri puerperalis belongs to the obstetrical emergencies. Immediate reposition, treatment of shock and the use of beta-mimetics can reduce morbidity and mortality. Surgery for reposition should be used if manual reposition failed.