American journal of obstetrics and gynecology
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We present the clinical course of a pregnant woman in septic shock. While we were managing this case, an elevated pulmonary capillary wedge pressure was found, expressing left ventricular dysfunction. Therefore we question the widely accepted and recommended practice of loading the pregnant women in septic shock with 1 to 2 L of crystalloids before the institution of central monitoring. It is our belief that an aggressive and earlier central monitoring of the hemodynamic status can result in better treatment decisions.
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Am. J. Obstet. Gynecol. · Dec 1997
Randomized Controlled Trial Clinical TrialNulliparous active labor, epidural analgesia, and cesarean delivery for dystocia.
Our purpose was to examine the effect of epidural analgesia on dystocia-related cesarean delivery in actively laboring nulliparous women. ⋯ With strict criteria for the diagnosis of labor and with use of a rigid protocol for labor management, there was no increase in dystocia-related cesarean delivery with epidural analgesia.
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Am. J. Obstet. Gynecol. · Nov 1997
Identifying twin gestations at low risk for preterm birth with a transvaginal ultrasonographic cervical measurement at 24 to 26 weeks' gestation.
Because twins are a high-risk group for preterm birth, many clinicians routinely use prophylactic interventions such as home bed rest, hospital bed rest, oral tocolytics, or home uterine activity monitoring to prevent preterm delivery. We sought to identify twin gestations at low risk for spontaneous preterm birth with transvaginal ultrasonography of the cervix to avoid the unnecessary use of prophylactic interventions in these pregnancies. ⋯ A transvaginal ultrasonographic measurement of the cervix of > 35 mm at 24 to 26 weeks in twin gestations can identify patients who are at low risk for delivery before 34 weeks' gestation.
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Am. J. Obstet. Gynecol. · Nov 1997
Meta AnalysisThe association of placenta previa with history of cesarean delivery and abortion: a metaanalysis.
Our purpose was to determine the incidence of placenta previa based on the available epidemiologic evidence and to quantify the risk of placenta previa based on the presence and number of cesarean deliveries and a history of spontaneous and induced abortion. ⋯ There is a strong association between having a previous cesarean delivery, spontaneous or induced abortion, and the subsequent development of placenta previa. The risk increases with number of prior cesarean deliveries. Pregnant women with a history of cesarean delivery or abortion must be regarded as high risk for placenta previa and must be monitored carefully. This study provides yet another reason for reducing the rate of primary cesarean delivery and for advocating vaginal birth for women with prior cesarean delivery.
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Am. J. Obstet. Gynecol. · Nov 1997
Multicenter StudyMulticenter study on the clinical value of fetal pulse oximetry. I. Methodologic evaluation. The French Study Group on Fetal Pulse Oximetry.
Our purpose was to evaluate the feasibility of intrapartum fetal pulse oximetry, the distribution of fetal oxygen saturation values, and the relationship with the neonatal outcome in a population with an abnormal fetal heart rate. ⋯ The feasibility of fetal pulse oximetry is satisfactory in clinical practice. It is easy to use and provides a fair rate of recorded values, even in a population with suspicion of fetal distress. A low fetal oxygen saturation is significantly associated with an abnormal neonatal outcome.