Obstetrics and gynecology
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Obstetrics and gynecology · Dec 2002
Review Comparative StudySystematic review of randomized controlled trials of misoprostol to prevent postpartum hemorrhage.
To assess the effects of prophylactic misoprostol use in the third stage of labor compared with injectable uterotonics or placebo or no treatment. ⋯ Injectable oxytocin or oxytocin-ergot preparations are more effective than misoprostol as part of the active management of the third stage of labor.
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Obstetrics and gynecology · Dec 2002
Review Comparative StudyPerspectives on the Women's Health Initiative trial of hormone replacement therapy.
The premature termination of one comparison in the Women's Health Initiative primary prevention trial due to stopping rules being reached necessitates a reconsideration of hormone replacement therapy (HRT). This part of the Women's Health Initiative trial, however, examined only one popular HRT regimen (conjugated equine estrogen [0.625 mg] and medroxyprogesterone acetate [2.5 mg] daily) in asymptomatic postmenopausal women. To help clinicians understand this large, complex trial, we describe several pervasive biases in earlier observational studies, review the principal findings of the trial, summarize recent systematic reviews, and offer clinical suggestions for HRT. ⋯ For women needing HRT, use of a low dose, with reassessments at least annually, appears prudent. Heart disease prevention strategies of proven value include exercise, weight control, blood pressure and lipid control, and avoidance of smoking. Hormone replacement therapy should not be used for this purpose.
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Obstetrics and gynecology · Nov 2002
ReviewExpectant management versus labor induction for suspected fetal macrosomia: a systematic review.
To systematically review and summarize the medical literature regarding the effects of expectant management and labor induction on mode of delivery and perinatal outcomes in patients with suspected fetal macrosomia. ⋯ Based on data from observational studies, labor induction for suspected fetal macrosomia results in an increased cesarean delivery rate without improving perinatal outcomes. Although their statistical power is limited, randomized clinical trials have not confirmed these findings.
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To review new evidence regarding ten controversial issues in the use of contraceptive methods among women with special conditions and to present World Health Organization recommendations derived in part from this evidence. ⋯ Of ten contraceptive method and condition combinations assessed, the evidence supported an increased risk of cardiovascular complications with combined OC use by women with hypertension or migraine. As new evidence becomes available, assessment of risk and recommendations for use of contraceptive methods can be revised accordingly.
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Obstetrics and gynecology · Nov 2001
Review Case ReportsSuccessful digoxin therapy of fetal supraventricular tachycardia in a triplet pregnancy.
Fetal supraventricular tachycardia is a rare complication of pregnancy associated with cardiac failure, hydrops, and fetal death. If no underlying cardiac defects are present, medical management with digoxin has been successful. ⋯ Digoxin might be used safely and successfully to treat fetal supraventricular tachycardia in multifetal pregnancies.