American journal of obstetrics and gynecology
-
Am. J. Obstet. Gynecol. · Apr 1986
Electrocardiographic changes associated with ritodrine-induced maternal tachycardia and hypokalemia.
One hundred twelve patients in preterm labor were followed prospectively, with electrocardiograms taken before ritodrine therapy and at 6 and 24 hours of treatment. Ninety-six percent of patients developed sinus tachycardia. Other changes were seen in 79% of the study group. ⋯ A drop in potassium concentration was noted initially, but a direct correlation between potassium concentrations and frequency of electrocardiographic changes was not present. We conclude that the electrocardiographic changes that are often observed during myocardial ischemia may be frequent in asymptomatic patients treated with ritodrine and that these changes may be a physiologic expression of ritodrine-induced tachycardia or hypokalemia. The validity of the use of the presence of electrocardiographic changes as the only criterion for discontinuation of ritodrine therapy is questioned.
-
Am. J. Obstet. Gynecol. · Mar 1986
Severe preeclampsia with persistent oliguria: management of hemodynamic subsets.
Nine patients with severe preeclampsia or eclampsia complicated by persistent oliguria failed to respond to fluid challenge and underwent pulmonary artery catheterization to guide further fluid and hemodynamic management. Three hemodynamic subsets of patients were defined. Patients in category I had low pulmonary capillary wedge pressure, hyperdynamic ventricular function, and moderate elevation of systemic vascular resistance. ⋯ A single patient (category III) exhibited markedly elevated wedge pressure and systemic vascular resistance and depressed ventricular function. Oliguria in this patient responded to volume restriction and aggressive afterload reduction. Hemodynamic observations in patients in category II imply the presence of selective vasodilator responsive renal arteriospasm in some preeclamptic patients with oliguria.
-
Birth defects caused by human teratogens are an important and potentially preventable cause of perinatal morbidity and mortality. Case reports provide an initial suggestion that a specific agent may be a human teratogen and provide the basis for further study. This review discusses the importance of case reports in human teratology and provides guidance in evaluating new case reports.
-
Am. J. Obstet. Gynecol. · Mar 1986
Blood transfusion and Jehovah's Witnesses: medical and legal issues in obstetrics and gynecology.
Jehovah's Witnesses are members of a religious denomination whose beliefs prohibit the use of blood or blood products. Plasma volume expanders and extracorporeal hemodilution of the patient's own blood are theologically acceptable. Acute massive hemorrhage in which only blood is lifesaving may be encountered in obstetrics and gynecology. ⋯ Factors to be considered include fetal viability, the presence of dependent children, and rules of informed consent. Whenever possible, the potential for transfusion should be anticipated and clearly discussed with the patient. When appropriate, the physician and hospital should move rapidly to obtain judicial resolution.
-
Am. J. Obstet. Gynecol. · Mar 1986
Case ReportsSubcutaneous emphysema, pneumomediastinum, and pneumothorax in labor and delivery.
Hamman's syndrome occurs rarely in the setting of labor and delivery. In this report 187 cases of Hamman's syndrome, with and without objective evidence of pneumothorax, are summarized and the literature reviewed. ⋯ Average fetal size (7 pounds, 14 ounces) was also found to be within normal limits. Signs, symptoms, and pathophysiology are reviewed and treatment discussed.