Obstetrics and gynecology
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Obstetrics and gynecology · Jul 2003
ReviewDiagnosis and management of gestational hypertension and preeclampsia.
Gestational hypertension and preeclampsia are common disorders during pregnancy, with the majority of cases developing at or near term. The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. In contrast, the onset of severe gestational hypertension and/or severe preeclampsia before 35 weeks' gestation is associated with significant maternal and perinatal complications. ⋯ Magnesium sulfate should be used during labor and for at least 24 hours postpartum to prevent seizures in all women with severe disease. There is an urgent need to conduct randomized trials to determine the efficacy and safety of antihypertensive drugs in women with mild hypertension-preeclampsia. There is also a need to conduct a randomized trial to determine the benefits and risks of magnesium sulfate during labor and postpartum in women with mild preeclampsia.
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Obstetrics and gynecology · Jul 2003
Randomized Controlled Trial Comparative Study Clinical TrialManagement of the second stage of labor in nulliparas with continuous epidural analgesia.
To determine if waiting for a strong urge to push in nulliparas with continuous low-concentration epidural analgesia shortens the pushing duration in the second stage. ⋯ In nulliparas with continuous low-concentration epidural analgesia, delaying pushing until a strong urge is felt does not reduce the duration of pushing in the second stage of labor.
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Obstetrics and gynecology · Jul 2003
Comparative StudySpontaneous versus induced labor after a previous cesarean delivery.
To compare maternal and neonatal outcomes in spontaneous versus induced labor after one previous cesarean delivery. ⋯ Induced labor is associated with an increased rate of early postpartum hemorrhage, cesarean delivery, and neonatal ICU admission. The higher rate of uterine rupture in those who had labor induced was not statistically significant.
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Obstetrics and gynecology · Jul 2003
ReviewEthical and medicolegal considerations in the obstetric care of a Jehovah's Witness.
Jehovah's Witnesses comprise a unique obstetric population. Their refusal of blood stems from an interpretation of a literal translation of the Bible, and it is this belief that puts them at an increased risk of morbidity and mortality if hemorrhage occurs. Many Jehovah's Witnesses feel that accepting a blood transfusion will lead them to eternal damnation. ⋯ This brings a new twist to the physician's obligation to "do no harm." When one undertakes the care of one of these patients, it is important to understand the ethical and medicolegal ramifications. The decision to be the primary caregivers can only be made once the physicians have decided they can let the patient die when all other options have been exhausted. This commentary discusses the ethical concerns and reviews the alternatives available to a Jehovah's Witness.
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Obstetrics and gynecology · Jul 2003
Comparative StudyThe influence of interpregnancy interval on the subsequent risk of stillbirth and early neonatal death.
To study whether interpregnancy interval is associated with increased risks of stillbirth and early neonatal death and whether this possible association is confounded by maternal characteristics and previous reproductive history. ⋯ Short interpregnancy intervals appear not to be causally associated with increased risk of stillbirth and early neonatal death, whereas long interpregnancy intervals were associated with increased risk of stillbirth and possibly early neonatal death.