Zentralblatt für Gynäkologie
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Review
[A guideline for guidelines--methodological report and use of the guideline women's information].
Information and education is needed to empower autonomy and self-determination of patients (informed consent). Furthermore reliable and accurate medical information is necessary for patients who want to take an active part in medical decision-making. The aim of this work is to define the requirements helping to assure the development of good qualified information material relevant for women and female patients as "a guideline on women information". An example of its use is given by embeding this guideline in the guideline for early detection of breast cancer in Germany by defining the specific elements required for developing qualified information on this issue for women. ⋯ The "guideline women information" is a systematically developed, consensus-based recommendation to improve the development of qualified lay information at the point of its process by defining gender-specific aspects required for good lay information and its evaluation. As a guideline for guidelines its use is demonstrated by integrating this guideline into the "guideline for early detection of breast cancer in Germany" to ensure the development of qualified guideline compliant information.
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Epidural analgesia for labour has been associated with an increased rate of motor blockade, and instrumental and Caesarean deliveries. In recent years, these risks were significantly reduced with modern concepts of epidural analgesia, including the use of lower doses of local anaesthetics in combination with opioids. With combinations of 0.0625-0.125 % of bupivacaine plus sufentanil or fentanyl, the incidence of maternal motor blockade approximates 10 % and most parturients are nowadays able to ambulate during labour. ⋯ The most common type of anaesthesia for Caesarean delivery is spinal anaesthesia due to its simplicity, cost-effectiveness and speed of onset. It is suitable for cases of an urgent or emergent Caesarean delivery. General anaesthesia still leads to a higher maternal mortality and should be reserved for absolute emergencies and cases where neuraxial blockade is contraindicated.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Treatment of a retained placenta with intraumbilical oxytocin injection.
The aim of the study was to assess the effect of intraumbilical administration of oxytocin in the management of retained placenta. This prospective double-blinded clinical study included 31 mothers with retained placenta. The women were divided into three groups: group 1 (n = 19) was given 20 IU syntocinon in 20 ml 0.9% NaCl saline intraumbilically into the vein (IUV); group 2 (n = 8) received 20 ml 0.9% NaCl saline; and group 3 (n = 4) received 0.2 mg ergometrine IUV in 20 ml 0.9% NaCl saline. ⋯ Febrility developed in one woman, and abdominal pain in two women from each group. Manual lysis of the placenta was performed in seven group 1, seven group 2, and all four group 3 women. IUV oxytocin injection provides a useful and inexpensive non-surgical, non-aggressive, cheap and pharmacological method which should be included in the treatment protocol for retained placenta before turning to the procedure of manual lysis of the placenta.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Conservative treatment vs. mastectomy without radiotherapy in aged women with breast cancer--a prospective and randomized trial.
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At the Clinic Obstetrics and Gynecology, Allgemeines Krankenhaus Celle, two cases of amniotic fluid embolism were observed. The first case showed the two characteristic phases of the disease (cardiopulmonary shock followed by severe disseminated intravascular coagulopathy). During the onset of the cardiorespiratory symptoms, the patient underwent cesarean section and a healthy infant was born. ⋯ Cesarean section was carried out immediately. At first, the infant was heavily depressed, but further development was normal. Inspite of great advances in intensive care amniotic fluid embolism still is considered to be a very dangerous event with 86% maternal mortality.