La Revue du praticien
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Vaginal delivery especially with dystocia, may result in relaxation or disruption of fascial and ligamentous supports of pelvic organs. The relationship between first childbirth and obstetric trauma is strong but additional pregnancies and deliveries are aggravating factors as well as ageing and hormonal effects of the menopause. ⋯ General practitioners can help at the time of postnatal control by making a full clinical evaluation of pelvic floor damage, referring women for further investigation and asking them about postnatal sexual difficulties. Postpartum perineal physiotherapy is indicated for women at risk: pelvic floor congenital weakness instrumental delivery, postpartum urinary and/or anal incontinence.
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Close collaboration of an informed anaesthetist with the obstetrician, and respect of the security protocols in every anaesthesia must guarantee the well-being of pregnant women. The development of loco-regional anaesthesia for use in labour analgesia and caesarean section has reduced the indications and the mortality related to general anaesthesia. ⋯ Epidural anaesthesia using low concentrations of local anaesthetics allows parturient ambulation. Intrathecal anaesthesia, with combined spinal-epidural technique, is mostly used for caesarean-section and for the early and late labour.
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Evidence-based therapeutic decisions in type 2 diabetes are considered here in terms of both the individual and public health policy. They lead to the recommendation which has proved to be the most effective: early, intensive, global care, first for glycemic control, then, according to the case, for the other risk factors of atheromatosis.