Obstetrical & gynecological survey
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Obstet Gynecol Surv · Aug 2010
Review Case ReportsSpontaneous rectus sheath hematoma pregnancy: case report and review of the literature.
Rectus sheath hematoma (RSH) is a rare, but important potential cause of acute upper abdominal pain in pregnancy. We report a patient with history of hemolysis, elevated liver enzymes, low platelets syndrome who presented with upper abdominal pain, hypotension, elevated hepatic transaminase levels, and a visibly enlarging right costal margin mass at 33 weeks' gestation. ⋯ Review of the published cases from the past 20 years shows that correct diagnosis remains difficult in pregnancy despite advances in diagnostic imaging. Although management of an RSH outside of pregnancy is frequently conservative, it is very often treated surgically in pregnant patients and often leads to preterm delivery.
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Obstet Gynecol Surv · May 2010
ReviewNicardipine for the treatment of severe hypertension in pregnancy: a review of the literature.
To evaluate the efficacy and safety of intravenous nicardipine for the treatment of severe hypertension in pregnancy. Articles were identified through electronic databases (Medline and Cochrane). No date or language restrictions were placed. Relevant citations were hand searched. The following search terms were used: pregnancy, severe hypertension and nicardipine. Patients included had chronic or gestational hypertension with or without marked proteinuria. Primary outcomes were reduction of systolic/diastolic and/or mean arterial pressure, time to target blood pressure, and severe maternal (hypotension, tachycardia) or severe fetal side effects (CTG abnormalities needing direct intervention). Five studies were found describing the use of nicardipine for treatment of severe hypertension in pregnancy. All studies were included in this review. One hundred forty-seven patients were treated. All patients had a significant reduction of both diastolic and systolic blood pressure. Treatment resulted in a 91% success rate in studies that defined success and 20% reduction of mean arterial blood pressure or systolic/diastolic blood pressure in 87%. Target blood pressure was reached within 23 minutes in 70% of the patients, 91% reached target blood pressure within 130 minutes. No severe maternal or fetal side effects were recorded. Nicardipine is a very effective therapy for treatment of severe hypertension in pregnancy and may be a better alternative to other available treatment options. ⋯ After completion of this article, the reader will be able to evaluate the relative effectiveness of nicardipine for the treatment of severe hypertension in pregnancy. Compare the side effect profile of nicardipine to labetolol for the treatment of severe hypertension in pregnancy and calculate the appropriate dosing of nicardipine for the treatment of hypertension in pregnancy.
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Obstet Gynecol Surv · Sep 2009
Review Case ReportsPregnancy and delivery in patients with fontan circulation: a case report and review of obstetric management.
The Fontan connection, originally described in 1971, is used to provide palliation for patients with many forms of congenital heart disease that cannot support a biventricular circulation. An increasing number of women who have undergone these connections in childhood are now surviving into adulthood, and some are becoming pregnant. The low flow and fixed cardiac output of a Fontan circulation pose a number of problems during pregnancy. Here, we report a case of a woman who underwent a Fontan procedure at age 7 and experienced significant cardiovascular decline before successfully delivering a viable infant at 33 weeks gestation. In addition, we reviewed the pertinent published data in this area, which suggests that pregnant patients with a Fontan circulation are more likely to face obstetrical, rather than cardiovascular, complications, including preterm labor, intrauterine growth restriction, an increased risk of cesarean section, and the potential need for anticoagulation. The review provides the obstetrician with the information needed to take a prominent role in the appropriate management of this rare, but growing, patient population. ⋯ Obstetricians & Gynecologists, Family Physicians Leaning Objectives: After completion of this article, the reader will be able to describe the Fontan circulation, describe the importance of the collaborative practice model for patients with Fontan circulation, and identify potential complications in the pregnancy of women with Fontan circulation.
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Obstetric brachial plexus palsy (OBPP), is an injury of the brachial plexus at childbirth affecting the nerve roots of C5-6 (Erb-Duchenne palsy-nearly 80% of cases) or less frequently the C8-T1 nerve roots (Klumpke palsy). OBPP often has medicolegal implications. In the United Kingdom and the Republic of Ireland the incidence is 0.42, in the United States 1.5, and in other western countries 1 to 3 per 1000 live births. Most infants with OBPP have no known risk factors. Shoulder dystocia increases the risk for OBPP 100-fold. The reported incidence of OBPP after shoulder dystocia varies widely from 4% to 40%. Other risk factors include birth weight >4 kg, maternal diabetes mellitus, obesity or excessive weight gain, prolonged pregnancy, prolonged second stage of labor, persistent fetal malposition, operative delivery, and breech extraction of a small baby. OBPP after caesarean section accounts for 1% to 4% of cases. Historically, OBPPs have been considered to result from excessive lateral traction and forceful deviation of the fetal head from the axial plane of the fetal body, usually in association with shoulder dystocia, which increases the necessary applied peak force and time to deliver the fetal shoulders. Direct compression of the fetal shoulder on the symphysis pubis may also cause injury. However a significant proportion of OBPPs occurs in utero, as according to some studies more than half of the cases are not associated with shoulder dystocia. Possible mechanisms of intrauterine injury include the endogenous propulsive forces of labor, intrauterine maladaptation, or failure of the shoulders to rotate, and impaction of the posterior shoulder behind the sacral promontory. Uterine anomalies, such as fibroids, an intrauterine septum, or a bicornuate uterus may also result in OBPP. It is not possible to reliably predict which fetuses will experience OBPP. Future research should be directed in prospective evaluation of the mechanisms of injury, to enable obstetricians, midwives, and other health care professionals to identify modifiable risk factors, develop preventive strategies, and improve perinatal outcomes. ⋯ After completion of this article, the reader will be able to summarize known risk factors for shoulder dystocia, describe the relationship between shoulder dystocia and obstetrics brachial plexus injuries, and describe three potentail explanantions for brachial plexus injuries other than lateral traction at delivery.
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Obstet Gynecol Surv · Jun 2009
ReviewManagement of Bartholin duct cysts and abscesses: a systematic review.
To review systematically the literature, published in English, on recurrence and healing after treatment of Bartholin duct cysts and abscesses. ⋯ After completion of this article, the reader should be able to identify seven different treatments for Bartholin duct cysts or abscesses, contrast treatment choice complications and recurrence risks for the different options for treatment of Bartholin duct cysts or abscesses, and point out the limited quality and quantity of data upon which to choose best practices.