American journal of obstetrics and gynecology
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Am. J. Obstet. Gynecol. · Oct 1999
Uterine rupture during induced or augmented labor in gravid women with one prior cesarean delivery.
Our purpose was to examine the risk of uterine rupture during induction or augmentation of labor in gravid women with 1 prior cesarean delivery. ⋯ Induction of labor with oxytocin is associated with an increased rate of uterine rupture in gravid women with 1 prior uterine scar in comparison with the rate in spontaneously laboring women. Although the rate of uterine rupture was not statistically increased during oxytocin augmentation, use of oxytocin in such cases should proceed with caution.
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Am. J. Obstet. Gynecol. · Oct 1999
Association between umbilical blood gas parameters and neonatal morbidity and death in neonates with pathologic fetal acidemia.
Our purpose was to correlate umbilical artery blood gas parameters with neonatal death and indicators of morbidity in neonates with pathologic fetal acidemia (pH <7.0). ⋯ Our data suggest that "pathologic" fetal acidemia is indicated by an umbilical artery pH <7.00 with a metabolic component. The metabolic component of fetal acidemia (ie, base deficit and bicarbonate) is the most important variable in subsequent neonatal morbidity. As expected, the umbilical artery PO (2) has no apparent clinical utility. The ability to predict more accurately which newborn infants with fetal acidemia are at risk of having complications may lead to a more efficient implementation of preventive measures.
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The purpose was to assess authorship trends over time by taking account of publication type and controlling for number of investigating centers and funding status in a multivariable analysis. ⋯ There is an inflationary trend in authorship that is not explained solely by the increased collaboration between centers and funding for research.
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Am. J. Obstet. Gynecol. · Aug 1999
Estrogen replacement therapy in women with previous breast cancer.
We sought to review the status of patients with breast cancer who were treated with estrogen replacement therapy and compare the results with those of nonestrogenic hormone users and women not treated with hormone replacement. ⋯ Estrogen replacement therapy apparently does not increase either recurrences or mortality rates. Adding progestogens may even decrease recurrences. Women with early breast cancer should be offered hormone replacement therapy after a full explanation of the benefits, risks, and controversies.
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Misoprostol, a prostaglandin E(1 ) analog, is widely used in the United States for cervical ripening and labor induction. Its use for these indications is not approved by the US Food and Drug Administration. The only Food and Drug Administration-approved indication in the product labeling is the treatment and prevention of intestinal ulcer disease resulting from nonsteroidal anti-inflammatory use. ⋯ Some trials also indicate increased frequencies of meconium passage, neonatal acidemia, and cesarean delivery for fetal distress in women receiving higher doses of misoprostol. Overall, most trials fail to demonstrate a significant change in the cesarean delivery rate with the use of this agent. Misoprostol is an effective agent for cervical ripening and labor induction when used in a judicious and cautious fashion.