Clinical obstetrics and gynecology
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Clin Obstet Gynecol · Sep 1998
ReviewSurgical management of pelvic organ prolapse and stress urinary incontinence.
There is no single operative approach to correct pelvic organ prolapse in conjunction with urinary and/or fecal incontinence or rectal prolapse. Each case needs to be individualized and dealt with surgically following the principles outlined in Table 1. ⋯ The genitourinary and reconstructive pelvic surgeon should have the skills to offer patients alternative approaches tailored to their individual symptomatology, and anatomic and pelvic pathology. Long-term follow-up of all patients is imperative to ascertain the clinical and cost effectiveness of these procedures.
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Clin Obstet Gynecol · Jun 1998
Review Comparative StudyEpidural analgesia for labor: effect on the cesarean birth rate.
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Vaginal birth or trial of labor after previous cesarean delivery represents one of the most significant changes in obstetric practice. There are numerous reasons that influence the decision to proceed with either a trial of labor after previous cesarean delivery or elective repeat cesarean delivery. For the majority of women with a previous cesarean delivery, a trial of labor should be encouraged. ⋯ At present, however, there is no sufficiently predictive method to identify those women most likely to benefit from an elective repeat cesarean delivery. The management of labor in women with a previous uterine scar is not low risk. As the number of women who attempt vaginal birth after previous cesarean delivery increases, we should focus on trying to develop reliable methods of identifying women who should and should not undertake a trial of labor after cesarean delivery.