American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Jun 2005
ReviewPerimortem cesarean delivery: were our assumptions correct?
A review of all published perimortem cesarean section case reports by Vern Katz, following up his article in 1986 first recommending this procedure.
While this does not offer proof of benefit (huge survival selection bias), of the 38 cases reported, 34 neonates survived (includes multiple gestations), and of the 20 cases with reversible causes, 13 mothers were discharged from hospital.
Katz writes:
summaryIn 12 of 18 reports that documented hemodynamic status, cesarean delivery preceded return of maternal pulse and blood pressure, often in a dramatic fashion. Eight other cases noted improvement in maternal status. Importantly, in no case was there deterioration of the maternal condition with the cesarean delivery.
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Am. J. Obstet. Gynecol. · Jun 2005
Case ReportsAcquired von Willebrand disease: management of labor and delivery with intravenous dexamethasone, continuous factor concentrate, and immunoglobulin infusion.
Acquired von Willebrand disease is a rare bleeding disorder that can lead to complete absence of clotting factor 8 and von Willebrand factor. Recently, the hematologic literature has reported continuous infusion of factor concentrates and intravenous immunoglobulin as an improved therapy for active bleeding and prophylaxis in patients who are anticipating surgery with congenital von Willebrand disease. We describe the first case of a pregnant woman with acquired von Willebrand disease who underwent the described therapy during delivery.
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Am. J. Obstet. Gynecol. · May 2005
The impact of occiput posterior fetal head position on the risk of anal sphincter injury in forceps-assisted vaginal deliveries.
A forceps-assisted vaginal delivery is a well-recognized risk factor for anal sphincter injury. Some studies have shown that occiput posterior (OP) fetal head position is also associated with an increased risk for third- or fourth-degree lacerations. The objective of this study was to assess whether OP position confers an incrementally increased risk for anal sphincter injury above that present with forceps deliveries. ⋯ Forceps-assisted vaginal deliveries have been associated with a greater risk for anal sphincter injury. Within this population of forceps deliveries, an OP position further increases the risk of third- or fourth-degree lacerations when compared with an OA position.
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To describe the clinical and electrodiagnostic findings, therapies, and outcomes of patients with pudendal neuralgia. ⋯ Pudendal neuralgia is poorly recognized and poorly treated. Improvement is gained with conservative therapy. Injections and decompression benefit one half and one third of patients, respectively. Neuromodulation needs further evaluation.
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Am. J. Obstet. Gynecol. · May 2005
Randomized Controlled Trial Clinical TrialBuccal misoprostol to prevent hemorrhage at cesarean delivery: a randomized study.
The purpose of this study was to assess the efficacy of buccal misoprostol to decrease uterine atony, hemorrhage, and the need for additional uterotonic agents during cesarean delivery. ⋯ Buccal misoprostol reduces the need for additional uterotonic agents during cesarean delivery.