Obstetrics and gynecology
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To review reports of the supine hypotensive syndrome with reference to clinical presentation, suggestions on the mechanism of onset, and the possibility of advance detection. ⋯ Supine hypotensive syndrome is characterized by severe supine symptoms and hypotension in late pregnancy, which compel the unconstrained subject to change position. Rarely, it may manifest even from the fifth month of pregnancy or postpartum, as well as in the pelvic tilt or sitting positions. Although inferior vena cava compression, influenced primarily by the size of the uterus and exact maternal and fetal position, is the major determinant in its development, other factors may also be important in modulating the circulatory effects of such compression. Advance recognition of susceptibility to the syndrome depends on a history of severe supine symptoms or supine intolerance and an increase in maternal heart rate and decrease in pulse pressure in the supine position. As there seems to be a spectrum of severity from minimal central cardiovascular alterations to severe syncopal shock resulting from supine inferior vena cava compression, it is difficult to define a cutoff point at which the syndrome occurs. Although usually recognizable by maternal symptoms, severe hypotension without symptoms has been reported on three occasions.
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We sought to determine whether the use of talc in genital hygiene increases the risk for epithelial ovarian cancer. ⋯ These data support the concept that a life-time pattern of perineal talc use may increase the risk for epithelial ovarian cancer but is unlikely to be the etiology for the majority of epithelial ovarian cancers.
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Obstetrics and gynecology · Dec 1991
ReviewPatient-controlled analgesia in obstetrics and gynecology.
Patient-controlled analgesia, which provides pain relief through self-administration of intravenous doses of opioids, is widely available and advocated as an effective analgesic modality. This report reviews published experiences with patient-controlled analgesia during labor and after cesarean delivery or major gynecologic surgery. Currently employed devices allow accurate record-keeping of drug use and permit patient mobility. ⋯ Compared with intramuscular administration of narcotics, patient-controlled analgesia after cesarean or major gynecologic surgery has been judged by patients to be more acceptable in achieving a balance between tolerable pain and sedation. Respiratory depression has been rare and is often attributable to misprogramming. Costs of these devices can be justified with frequent usage and are at least partially offset by more efficient use of nursing personnel for pain management.
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Obstetrics and gynecology · Sep 1991
ReviewDiagnosis and management of chronic hypertension in pregnancy.
Pregnancies complicated by chronic hypertension are at increased risk for the development of superimposed preeclampsia, abruptio placentae, and poor perinatal outcome. The frequency of these complications is particularly increased in patients with severe hypertension and those with preexisting cardiovascular and renal disease. Such women should receive appropriate antihypertensive therapy and frequent evaluations of maternal and fetal well-being. ⋯ No differences in pregnancy outcome were found with the use of antihypertensive drugs. Evaluation of the woman with chronic hypertension who is considering pregnancy should begin before conception to establish the cause and severity of the hypertension. Appropriate management should include frequent evaluation of maternal and fetal well-being; antihypertensive medications may be useful in patients with severe disease as well as in those with target organ involvement.
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Obstetrics and gynecology · Mar 1990
ReviewNonimmune hydrops fetalis associated with genetic abnormalities.
The purpose of this review of the literature on nonimmune hydrops fetalis was to evaluate whether recent clinicopathologic studies have modified the relative incidence of the different associated conditions and the management of these pregnancies. We found 600 cases of nonimmune hydrops fetalis published since 1982. These cases were reviewed with particular attention to genetic causes and were compared with a literature review of 298 cases published before 1982. ⋯ The most frequently identified genetic abnormalities in our review were chromosomal disorders (15.7%), alpha-thalassemia (10.3%), skeletal dysplasia (4%), arthrogryposis multiplex syndromes (1.8%), multiple pterygium syndrome (1.5%), and lysosomal storage disorders (1.0%). These results confirm the need for systematic chromosome analysis in fetuses with nonimmune hydrops. From this review, we conclude that prenatal noninvasive and invasive techniques combined with detailed pathologic studies have improved the accuracy of diagnosis of the underlying causes of nonimmune hydrops fetalis and have influenced the management of these pregnancies.