Obstetrics and gynecology
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Obstetrics and gynecology · Feb 2006
Review Case ReportsExtracorporeal membrane oxygenation therapy for circulatory arrest due to postpartum hemorrhage.
Cardiac arrest after postpartum hemorrhage may not respond to advanced life support. Various resuscitation methods have been proposed, including sternotomy and direct cardiac massage. Extracorporeal membrane oxygenation (ECMO) might be an alternative. ⋯ Aggressive mechanical circulatory support, such as ECMO, should be considered in a case of potentially reversible cardiocirculatory failure in a young obstetric patient.
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Obstetrics and gynecology · Dec 2005
ReviewHypoxic ischemic encephalopathy and hypothermia: a critical look.
Hypoxic ischemic encephalopathy is a rare condition associated with high neonatal mortality and morbidity. Two randomized clinical trials have recently been published showing potentially promising results with hypothermia for neonatal encephalopathy. Additional clinical trials are underway to test cooling as a therapeutic modality for hypoxic ischemic encephalopathy. ⋯ Longer-term outcome (ie, school age information) is currently lacking with respect to benefit and risk. Therapeutic hypothermia offers a potentially promising therapy for hypoxic ischemic encephalopathy. Hypothermia for encephalopathy should be considered an evolving therapy because of lack of long-term safety and efficacy data.
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The obstetrician-gynecologist who provides expert witness testimony is recognized as an important participant in the medical liability system. He or she must define a standard of care and opine whether the standard has been breached and whether any perceived injury was caused by the breach. The American College of Obstetricians and Gynecologists (ACOG) ethical guidelines insist that the testimony be objective (free from intentioned distortion) and that the witness not assume an advocacy or partisan role. ⋯ Members of ACOG should be held to more restrictive ACOG guidelines and egregious testimony condemned by ACOG. Prospective peer review, increased judicial review, and testimony banks are other examples of methods to improve the quality of expert witness testimony. Alternatives to litigation for medical liability disputes and further tort reform might also make the system fairer and more sustainable.
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Obstetrics and gynecology · Jul 2005
Review Meta Analysis Comparative StudyCerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data.
Preterm birth is the main cause of perinatal morbidity and mortality. A short cervical length on transvaginal ultrasonography predicts preterm birth. Our aim was to estimate by meta-analysis of randomized trials whether cerclage prevents preterm birth in women with a short cervical length. ⋯ Cerclage does not prevent preterm birth in all women with short cervical length on transvaginal ultrasonography. In the subgroup analysis of singleton gestations with short cervical length, especially those with a prior preterm birth, cerclage may reduce preterm birth, and a well-powered trial should be carried out in this group of patients. In contrast, in twins, cerclage was associated with a significantly higher incidence of preterm birth.