American journal of obstetrics and gynecology
-
The purpose of this study was to evaluate patient satisfaction for oral analgesia for postcesarean pain management. ⋯ Oral, nonnarcotic, postcesarean analgesia provides satisfactory pain relief. Patient satisfaction can be further enhanced by providing the medications in fixed time intervals rather than leaving it to patient request.
-
Am. J. Obstet. Gynecol. · Sep 2002
A state-wide assessment of the obstetric, anesthesia, and operative team personnel who are available to manage the labors and deliveries and to treat the complications of women who attempt vaginal birth after cesarean delivery.
The purpose of this study was to determine on a state-wide basis the range of obstetric, anesthesia, and surgical team personnel who were available immediately to manage the labors and deliveries of women who attempted vaginal birth after cesarean delivery. Additionally, we tried to determine whether hospitals had stopped performing vaginal births after cesarean delivery or made changes in their policies regarding vaginal birth after cesarean delivery as a result of recent American College of Obstetricians and Gynecologists recommendations. ⋯ Most level I and many level II hospitals provide less than optimum staffing when women are attempting vaginal birth after cesarean delivery. Because vaginal births after cesarean delivery are equally distributed among level I, II, and III institutions in this state, many women may be attempting vaginal birth after cesarean delivery under less than optimal conditions. The data suggest the need for changes in staffing or referral patterns to safely meet the Healthy People 2010 goal of increasing the vaginal birth after cesarean delivery rate nationally.
-
Am. J. Obstet. Gynecol. · Sep 2002
Ethical challenges of decision making with pregnant patients who have schizophrenia.
Because there is a dearth of literature, we developed an ethical framework to guide decision making about the management of pregnancy of patients with schizophrenia. ⋯ The preventive ethics strategies of assisted and surrogate decision making can be used to prevent ethical conflicts in decision making about the management of pregnancy of patients with schizophrenia. These preventive ethics strategies should contribute significantly to reducing the vulnerability of these patients and therefore to enhancing their autonomy in the physician-patient relationship.
-
Am. J. Obstet. Gynecol. · Aug 2002
Necrotizing fasciitis in gynecologic and obstetric patients: a surgical emergency.
We reviewed the cases of 23 patients who were admitted to the hospital with a primary diagnosis of histopathologically confirmed necrotizing fasciitis in the lower abdomen or pelvis. Rapid demise of a healthy postpartum women piqued our interest in trying to identify the early signs and symptoms that may lead to earlier diagnosis and treatment of this often fatal disease. ⋯ Necrotizing fasciitis is a rapidly progressive, often lethal, infectious disease process that requires early aggressive debridement. Any patient with inordinate pain and unilateral edema in the pelvis, especially in the puerperium, should be suspected of having this disease. Radiographic studies are often diagnostic of this condition. The triad of pelvic pain, edema, and any sign of septicemia carries an extremely grave prognosis and mandates immediate surgical intervention.