Obstetrics and gynecology
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Obstetrics and gynecology · Sep 1989
ReviewPulse oximetry: a review of the theory, accuracy, and clinical applications.
Pulse oximetry has emerged as a clinical tool in anesthesia and newborn monitoring within the last 7 years as a result of recent technological and theoretical advances. Oximeters measure the different absorption spectra of oxygenated and deoxygenated hemoglobin. Electronic measures of oxygenation at the peak of the pulse allow computation and display of oxygen saturation of the arterial blood almost instantly. ⋯ Factors adversely affecting the accuracy of pulse oximeter output include transducer movement, peripheral vasoconstriction, a nonpulsating vascular bed, hypotension, anemia, changes in systemic vascular resistance, hypothermia, presence of intravascular dyes, and nail polish. Pulse oximetry has been used to monitor oxygen saturation intraoperatively in the adult and neonatal intensive care units and to monitor pregnant patients and their infants at delivery. Once the advantages and limitations of pulse oximetry are recognized, this monitoring technique can play an important role in the care of patients with cardiovascular and respiratory compromise.
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Obstetrics and gynecology · Sep 1988
ReviewGastrointestinal complications in gynecologic surgery: a review for the general gynecologist.
A working familiarity with the management of common perioperative gastrointestinal complications is required for all general gynecologists. Thermal gastrointestinal injury requires resection of the damaged portion of bowel unless the injury involves only the bowel serosa and is less than 0.5 cm in diameter. Small intraoperative lacerations of the intestine can be closed primarily, whereas larger lacerations often require resection. ⋯ Small-bowel obstruction, most likely to be caused by postoperative adhesions, can often be treated successfully by gastrointestinal intubation. Steps required in the initial management of an enterocutaneous fistula include institution of parenteral nutritional supplementation and antibiotics, skin protection, and investigative studies of the fistula. Preventive measures may be used at the time of any surgical procedure to reduce the incidence of many of these complications.
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Obstetrics and gynecology · Sep 1988
Review Historical ArticleThe conquest of cesarean section-related infections: a progress report.
More than a century ago, Robert P. Harris demonstrated convincingly that death from infection after cesarean section could be reduced significantly by operating early, rather than after several days of labor, by using aseptic surgical technique, and by closing the uterine incision. ⋯ These can be reduced by proper management of labor, by recognizing the need for cesarean section early, by using alternative methods for delivery when appropriate, by meticulous surgical technique, and by selective use of prophylactic antibiotics. These changes are not likely to occur unless care of obstetric patients is assumed by experienced obstetricians who are prepared to recognize and correct abnormal labor early and to perform instrumental extraction and vaginal breech deliveries rather than cesarean section in carefully selected patients.
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High-risk pregnancies require specialized obstetric and anesthetic care. A basic understanding of how specific pathophysiology and pharmacologic therapy interact with anesthetic care is essential for both obstetrician and anesthesiologist. This paper selectively focuses on preeclampsia/eclampsia, diabetes mellitus, prematurity, multiple gestations, infectious disease, preexisting neurologic disease, and preexisting cardiac disease, reviewing anesthesia for labor and vaginal and cesarean delivery for each high-risk problem, as practiced at a Level III perinatal unit. Emphasis will be placed, when appropriate, on recent experience with monitoring and aggressive pharmacologic therapy of the critically ill parturient.
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This is the first published recommendation for perimortem cesarean sections in maternal cardiac arrest – from Katz, Dotters and Droegemueller (1986).
It was this recommendation that lead to the ‘4 minute rule’ for deciding to commence a CS in a resuscitation scenario, with the aim of delivering the baby within 5 minutes.
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