Best practice & research. Clinical obstetrics & gynaecology
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Perineal infections are a common presenting complaint in women attending acutely to a gynaecology department. Specifically, Bartholin's abscesses can occur in approximately 2% of women. Conservative versus surgical approaches to manage these infections aims to reduce the need for hospital admission. We summarise the literature on the diagnosis and management of Bartholin's and other types of perineal infections and abscesses specific to gynaecology.
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Nausea and vomiting occur in up to 80% of normal pregnancies. Hyperemesis gravidarum, resulting in dehydration and ketonuria, is a more severe, disabling and potentially life threatening condition affecting up to 1.5% of pregnancies. ⋯ There are good safety data to support the use of antihistamines, phenothiazines and metoclopromide in hyperemesis gravidarum, though trials of efficacy are lacking and there is little evidence on which to chose the optimum therapy. This review discusses the diagnosis and management of hyperemesis gravidarum and the prevention, recognition and treatment of the serious complications of Wernicke encephalopathy, osmotic demyelination syndrome and thromboembolism.
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Miscarriage is the most common serious pregnancy complication affecting approximately 30% of biochemical pregnancies and 11-20% of clinically recognised pregnancies. The diagnosis of miscarriage is made most commonly by trans-vaginal ultrasound (TVS) assessment. Evidence-based criteria should be employed for the diagnosis of delayed and incomplete miscarriage. ⋯ Prediction of the diagnosis of miscarriage using maternal history and ultrasound features may be helpful in counselling women towards likely pregnancy outcome and planning appropriate further assessment. Use of three-dimensional ultrasound has not improved diagnosis of miscarriage. After a diagnosis of miscarriage, half the women undergo significant psychological effects, which may last for up to 12 months.
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The management of the unconscious pregnant patient encompasses many aspects of obstetrics and critical care. It is not uncommon to have to manage such a patient, therefore one needs to be well prepared. There is a spectrum of altered consciousness, brain death being the most extreme. ⋯ A multidisciplinary approach would be prudent. The intermediate and long-term management should also involve the family. The issues of perimortem and somatic support for foetal maturity are also discussed.
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Best Pract Res Clin Obstet Gynaecol · Jun 2009
Severe acute maternal morbidity in high-income countries.
Maternal mortality in high income countries has become low in recent years and therefore analysis of severe acute maternal morbidity has been added to confidential enquiries into the causes of maternal deaths. The major drawback at the moment is the lack of universal definitions of severe acute maternal morbidity. ⋯ Audit is the instrument to analyse whether substandard care factors are present. Guidelines and protocols to provide obstetric critical care may be improved from audit findings and skills and drills training put in place.