Ginekol Pol
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Pregnancy is not only a medical but also a psychological and social event. There are many situations combined with pregnancy that in medical terms, constitute a risk, danger or failure and result in a wide range of emotional reactions in a woman that require special care and attention for her psychological functioning. ⋯ Early and distant consequences of a pregnancy loss were discussed here especially in the context of a woman's mental health and children of the mothers who had experienced such failure in the past. The aim of this paper was to present an optimal way of taking care of women after pregnancy loss on the basis of the standards that were created in the Gynecological and Obstetrical Clinical Hospital in Poznań.
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Vaginal birth after cesarean delivery has recently become a significant problem in obstetrics. The purpose of this paper was to present current expert knowledge about vaginal birth after cesarean delivery (VBAC), taking into account advantages and disadvantages mentioned in literature.
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With recent advances in prenatal care, the incidence of direct causes of maternal death has declined and indirect causes have gained significant importance. Thromboembolism, hypertension and cardiovascular diseases are the most common indirect causes of maternal death. ⋯ The issue of pregnancy of heart transplant--and Turner syndrome--patients requires extensive research. Obstetricians should possess good knowledge of cardiovascular complications of pregnancy because a high index of suspicion and early diagnosis, together with timely and appropriate interventions may save the life of the fetus and the mother.
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Pregnancy and puerperium increase the risk of venous thromboembolic disease. As it is potentially life-threatening, all patients with the suspicion of pulmonary embolism require proper diagnosis and, possibly treatment. Venous ultrasonography is usually applied. ⋯ In treatment of pulmonary embolism, low molecular weight heparins play the key role. However; in case of dramatic pulmonary embolism with shock and hypotension, thrombolytic therapy may be necessary. Low molecular weight heparins as well as oral anticoagulants can be used after the delivery.
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Pulmonary embolism is the main cause of death of pregnant women in developed countries. An increased prothrombotic activity is observed during pregnancy. Moreover, the risk of venous thromboembolic disease can be elevated in cases of inherited thrombophilia, antiphospholipid syndrome or previous venous thromboembolic events. According to presented guidelines of The Royal College of Obstetricians and Gynecologists and The American College of Chest Physicians, the risk stratification of venous thromboembolic disease during pregnancy and puerperium is a vital condition and proper antithrombotic prophylaxis should be implemented.