Current opinion in obstetrics & gynecology
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A variety of congenital viral infections are responsible for a large proportion of the mortality and morbidity in infancy and childhood. Vertical transmission may occur during primary maternal infection or during chronic or recurrent infection, with different implications for counselling and testing in pregnancy. Strategies for the diagnosis and prevention of mother-to-child transmission differ according to the timing and mechanisms involved. As demonstrated by hepatitis B research in the past and human immunodeficiency virus today, multicenter cohort studies and clinical trials are a key to developing effective interventions.
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There is an increasing trend towards non-invasive diagnosis and conservative treatment for early pregnancy problems. Although there are enormous potential benefits for women being treated thus, the ideal treatment methods and diagnostic algorithms have yet to be elucidated. Further large-scale studies are required.
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Pregnancy rates with endometriosis-associated infertility may be improved by laparoscopic surgery or laparotomy for moderate to severe disease. Surgery for minimal to mild disease does not increase pregnancy rates. ⋯ Pregnancy rates with assisted reproductive technology for endometriosis appear to be comparable with those for tubal disease that are also treated with assisted reproductive technology. Medical and surgical treatments for pelvic pain with endometriosis are both effective, but surgery avoids the side-effects associated with drugs and may result in a lower recurrence rate.
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Most cases of postpartum haemorrhage are caused by uterine atony, maternal soft-tissue trauma, retained placenta or its parts, and obstetric coagulopathy. The factors most significantly associated with haemorrhage include advanced maternal age, prolonged labour, pre-eclampsia, obesity of mother, multiple pregnancy, a birth weight of more than 4000g, and previous postpartum haemorrhage. It seems that multiparity itself is only a weakly associated factor. ⋯ The uterine tamponade with gauze or specific tubes may also be a useful alternative in some cases. Selective arterial embolization is a promising new method that seems to have success in controlling the heavy postpartum bleeding unresponsive to more usual measures. However, the value of this method should be evaluated in bigger series.