Obstetrics and gynecology clinics of North America
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Venous thromboembolism in pregnancy is a clinical emergency that has been associated with significant risk for maternal and fetal morbidity and mortality. The adaptation of the maternal hemostatic system to pregnancy predisposes women to an increased risk of thromboembolism. ⋯ Recent clinical guidelines identify compression venous ultrasound as the best way to diagnose deep venous thrombosis in pregnancy and CT pulmonary angiography as the best way to diagnose pulmonary embolism in pregnancy. Therapy involves supportive care and anticoagulation with unfractionated or low molecular weight heparin, depending on the clinical scenario.
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Postpartum hemorrhage (PPH) is the leading cause of death related to pregnancy worldwide. Most deaths resulting from PPH are preventable. ⋯ Reducing the incidence of PPH and the mortality resulting from the condition should be a key goal of obstetrics services worldwide. This article focuses on the etiology, prediction, prevention, and management of PPH.
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Although pregnancy and delivery in the United States are usually safe for mother and her newborn child, serious maternal complications, including cardiac arrest, can occur in the prenatal, intrapartum and postpartum periods. The clinical obstetrician can expect to encounter this complication in his or her career. The obstetrician must be aware of the special circumstances of resuscitation of the gravid woman to assist emergency medicine and critical care physicians in reviving the patient. Understanding the decision process leading to the performance of a perimortem cesarean and the actual performance of the cesarean delivery clearly are the responsibility of the obstetrician.
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Hemorrhage is the leading cause of intensive care unit admission and one of the leading causes of death in the obstetric population. This emphasizes the importance of a working knowledge of the indications for and complications associated with blood product replacement in obstetric practice. This article provides current information regarding preparation for and administration of blood products, discusses alternatives to banked blood in the obstetric population, and introduces pharmacological strategies for treatment of hemorrhage.
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Obstet. Gynecol. Clin. North Am. · Mar 2007
ReviewFamily planning American style: why it's so hard to control birth in the US.
The US problems of high unintended pregnancy and abortion can be successfully addressed with a systems approach that focuses on reducing barriers to contraception and improving opportunities to expand access. The ability to reduce unintended pregnancy depends on making family planning services available to all. A comprehensive approach requires policy change to improve funding for and access to family planning, to provide comprehensive sex education and to reduce insurance and religious barriers to contraceptives.