European journal of obstetrics, gynecology, and reproductive biology
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Mar 2013
Review Case ReportsStarvation ketoacidosis in pregnancy.
Starvation ketosis outside pregnancy is rare and infrequently causes a severe acidosis. Placental production of hormones, including glucagon and human placental lactogen, leads to the insulin resistance that is seen in pregnancy, which in turn increases susceptibility to ketosis particularly in the third trimester. Starvation ketoacidosis in pregnancy has been reported and is usually precipitated by a period of severe vomiting. ⋯ This article features four cases of women with vomiting in the third trimester of pregnancy associated with a severe metabolic acidosis. The mechanism underlying ketogenesis, the evidence for accelerated ketogenesis in pregnancy and other similar published cases are reviewed. A proposed strategy for management of these women is presented.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Mar 2013
Comparing different diagnostic approaches to severe maternal morbidity and near-miss: a pilot study in a Brazilian tertiary hospital.
Despite recent guidelines proposed by the World Health Organization (WHO), the operational definition of maternal near-miss (MNM) is still heterogeneous. This study aimed at evaluating the pros and cons of three instruments in characterizing MNM cases. The performance of two of the three instruments was also investigated vis-à-vis the WHO criteria. ⋯ These results underline that different approaches entail heterogeneous estimates of MNM. The Waterstone and the literature-based criteria are not suitable for a definitive diagnosis of MNM in view of their low PPV, but they seem adequate as a first approach in investigating MNM. While negative results by both alternative criteria virtually rule out MNM, a positive result would require a reassessment using the WHO criteria to confirm the diagnosis of maternal near-miss.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Mar 2013
Association of low maternal levels of salusins with gestational diabetes mellitus and with small-for-gestational-age fetuses.
To evaluate maternal and cord serum concentrations of salusin-α and salusin-β in women with gestational diabetes mellitus (GDM) and with small-for-gestational age (SGA) fetuses. ⋯ The low levels of maternal serum salusin-α and salusin-β may have negative impact on metabolic disorders and vascular dysfunction.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Feb 2013
Management of large adnexal tumors by isobaric laparoendoscopic single-site surgery with a wound retractor.
To report our experience with isobaric transumbilical laparoendoscopic single-site surgery for the management of large adnexal tumors exceeding 500g of excised tissue weight including cystic contents. ⋯ The transumbilical wound retraction system combined with an intra-abdominal fan retractor appears to contribute favorably to laparoendoscopic single-site surgery for the management of large adnexal tumors, because the device permits flexible and wide circumferential access by efficient wound retraction during instrumentation without the need for closed condition associated with pneumoperitoneum.
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Eur. J. Obstet. Gynecol. Reprod. Biol. · Jan 2013
Review Meta AnalysisAnalgesic effectiveness of transversus abdominis plane blocks after hysterectomy: a meta-analysis.
To determine the effectiveness of transversus abdominis plane blocks in gynecological surgery by systematic review and meta-analysis. Embase, MEDLINE and the Cochrane Library (CENTRAL) bibliographic databases were searched using a Cochrane Library search strategy modified for gynecological surgery. We included randomized controlled trials comparing transversus abdominis plane block with no block or placebo block. ⋯ Transversus abdominis plane block resulted in significantly less postoperative requirement for morphine use at 24h (-11.76 mg, 95% CI -18.77 to -4.75) but not at 48 h (-16.01 mg, 95% CI -39.40 to 7.39). Evidence exists for the short-term efficacy (within 24 h) of transversus abdominis plane blocks during hysterectomy in terms of reported pain and morphine consumption, which may not be sustained at 48 h. Updates to this review should be undertaken periodically, and until further robust evidence is available, anesthetists should not rush to adopt this procedure into routine practice.