Ceská gynekologie / Ceská lékarská spolecnost J. Ev. Purkyne
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The authors apply the language and concepts of ethics to the problem of differences between the gynecologist and the patient about what is in the patient's interest. We develop a framework for clinical judgment and decision making about the ethical dimensions of the gynecologist-patient relationship. ⋯ We then show how these two principles interact in clinical judgement and decision making using common examples from gynecologic practice. We examine factors that influence the relative weight of these principles, including subject matter, probability of net medical benefit, availability of reasonable alternatives, and ability of the patient to participate in the informed consent process.
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Historical Article
[Development of obstetrical analgesia and anesthesia in the Czech Republic].
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At present increasingly liquid media are preferred to gaseous ones in hysteroscopic procedures. In operations the former media are used almost exclusively. ⋯ Medium escapes also via the oviducts into the peritoneal cavity. It is therefore necessary to adhere to safety measures which include in particular selection of a suitable medium, the time factor, correct surgical procedure and specially continuous control of consumption of the medium.
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The authors compared the length of labour periods, number of surgical deliveries, the use of oxytocin, analgetics, spasmolytics and intensity of pain in two groups of primiparae, who were in labor under continuous epidural analgesia (CEA). In the first group CEA was started when the cervix was dilated not more than 3 cm, in the second one when the cervix was dilated more than 3 cm. The length of labour, oxytocin consumption and frequency of vaginal surgery did not differ in the two groups. In the first group there was great consumption of analgetics and spasmolytics, more motor blocks of the lower extremities and a higher rate of Caesarean sections on account of dystocia. In some of the women of the first group the intensity of pain at the end of the first stage of labour and during the second stage was higher than before the onset of CEA. ⋯ It seems to be better to start CEA when the cervix is dilated more than 3 cm.