Clinical obstetrics and gynecology
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This review explores current concepts surrounding breastfeeding complications including nipple pain and trauma, breast engorgement, mastitis, and breast abscess. The review discusses possible etiologies, risk factors, incidence, differential diagnosis, and suggested treatment strategies. The evidence that supports these management options is discussed.
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Clin Obstet Gynecol · Sep 2015
ReviewVulvar and Vaginal Atrophy: Physiology, Clinical Presentation, and Treatment Considerations.
Vulvovaginal atrophy is a common condition associated with decreased estrogenization of the vaginal tissue. Symptoms include vaginal dryness, irritation, itching, soreness, burning, dyspareunia, discharge, urinary frequency, and urgency. ⋯ Despite the high prevalence and the substantial effect on quality of life, vulvovaginal atrophy often remains underreported and undertreated. This article aims to review the physiology, clinical presentation, assessment, and current recommendations for treatment, including aspects of effectiveness and safety of local vaginal estrogen therapies.
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Cardiac arrest is a rare event during pregnancy. The pregnant population represents a unique subset of cardiac arrest victims. Not only are there unique causes of circulatory collapse during the pregnant state, but the physiological modifications to the maternal physiology during pregnancy require specific modifications to the standard management of the arrest. Lastly, the pregnant victim presents herself with the challenges of a second patient who needs to be considered in the decision-making process.
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Hemorrhage is the most common cause of maternal mortality worldwide, and represents the third most common obstetrical cause of maternal death in the United States. Although uterine atony was previously a major cause of peripartum hemorrhage, more recently, it appears that abnormal placentation is the leading etiology and the main indication of peripartum hysterectomy. Early identification and aggressive management of obstetrical hemorrhage is of utmost importance to prevent maternal morbidities and mortality.
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Acute respiratory distress syndrome (ARDS) is an uncommon condition in pregnant patients. The causes of ARDS are associated with obstetric causes such as amniotic fluid embolism, preeclampsia, septic abortion, and retained products of conception or nonobstetric causes that include sepsis, aspiration pneumonitis, influenza pneumonia, blood transfusions, and trauma. ⋯ Medical therapies such as nitric oxide and corticosteroids play a complimentary role. Extracorporeal life support is beneficial in the management of the parturient with severe ARDS.