J Reprod Med
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To determine the impact of introducing epidural analgesia for labor pain relief on the primary cesarean and forceps delivery rates. ⋯ Epidural analgesia was not associated with an increase in the primary cesarean delivery rate but was associated with an increase in the operative vaginal delivery rate.
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Case Reports
Neurosarcoidosis diagnosed during pregnancy by thoracoscopic lymph node biopsy. A case report.
Sarcoidosis is a multiorgan-system granulomatous disease causing respiratory complaints in most patients. Eye involvement, most commonly granulomatous uveitis, is seen in 5% of black patients with sarcoidosis. Neurosarcoidosis is also rare, affecting 5% of patients with sarcoidosis. Thoracoscopic lymph node biopsy in pregnancy has never before been reported. ⋯ The diagnosis of sarcoidosis remains one of exclusion and requires a high index of suspicion. Tissue confirmation is often necessary, especially when patients have extrathoracic complaints. For patients without other lesions amenable to biopsy, thoracoscopic lymph node biopsy can be considered despite pregnancy.
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To determine whether high-risk human papillomavirus (HPV) DNA testing could improve the detection of cervical intraepithelial neoplasia (CIN) and cancer in older women (> or = 50 years old) with mildly abnormal results on conventional cytology. ⋯ The addition of a high-risk HPV DNA assay to cytologic examination appears to provide excellent sensitivity and negative predictive value for early detection of high grade CIN or cancer in older women with minimally abnormal Pap smears.
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Case Reports
Bladder rupture associated with uterine rupture. A report of two cases occurring during vaginal birth after cesarean.
Uterine rupture occurs in < 1% of patients undergoing a trial of labor after cesarean section. Associated injury to adjacent organs within the maternal pelvis has likewise been very rarely reported. ⋯ Bladder rupture may be associated with uterine rupture during attempted vaginal birth after cesarean. The potential for bladder injury should be included in the patient's antepartum counseling.
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Tuberculosis of the endometrium is usually associated with infertility. Once a patient is diagnosed with endometrial tuberculosis, she is almost certain to experience infertility; in vitro fertilization and embryo transfer offer the only realistic treatment for tuberculous infertility. We describe one case of unassisted conception with a normal pregnancy outcome in a patient with Mycobacterium tuberculosis infection of the endometrium. ⋯ Despite the successful fertility outcome in our patient, we do not think that this case was a challenge to previous concepts of endometrial tuberculosis. In vitro fertilization and embryo transfer are usually the most suitable options for these patients.