Managing Complications in Pregnancy and Childbirth: a Guide for Midwives and Doctors
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Incidence, Risk Factors and Management of Severe Post-Transsphenoidal Epistaxis Q ⇑ Kenneth M
Journal of Clinical Neuroscience 22 (2015) 116–122 Contents lists available at ScienceDirect Journal of Clinical Neuroscience journal homepage: www.elsevier.com/locate/jocn Clinical Study Incidence, risk factors and management of severe post-transsphenoidal epistaxis q ⇑ Kenneth M. De Los Reyes a, Bradley A. Gross a, , Kai U. Frerichs a, Ian F. Dunn a, Ning Lin a, Jordina Rincon-Torroella a, Donald J. Annino b, Edward R. Laws a a Department of Neurological Surgery, Brigham and Women’s Hospital and Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA b Department of Otolaryngology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA article info abstract Article history: Among the major complications of transsphenoidal surgery, less attention has been given to severe post- Received 16 June 2014 operative epistaxis, which can lead to devastating consequences. In this study, we reviewed 551 consec- Accepted 2 July 2014 utive patients treated over a 4 year period by the senior author to evaluate the incidence, risk factors, etiology and management of immediate and delayed post-transsphenoidal epistaxis. Eighteen patients (3.3%) developed significant postoperative epistaxis – six immediately and 12 delayed (mean postoper- Keywords: ative day 10.8). Fourteen patients harbored macroadenomas (78%) and 11 of 18 (61.1%) had complex Endoscopic nasal/sphenoid anatomy. In the immediate epistaxis group, 33% had acute postoperative hypertension. Epistaxis In the delayed group, one had an anterior ethmoidal pseudoaneurysm, and one had restarted anticoagu- Management Microscopic lation on postoperative day 3. We treated the immediate epistaxis group with bedside nasal packing fol- Pituitary lowed by operative re-exploration if conservative measures were unsuccessful. -
Complication Prevention for Patients with Diabetes a Noncommunicable Disease Education Manual for Primary Health Care Professionals and Patients
Complication prevention for patients with diabetes A noncommunicable disease education manual for primary health care professionals and patients Complication prevention for patients with diabetes A noncommunicable disease education manual for primary health care professionals and patients The Noncommunicable Disease Education Manual for Primary Health Care Professionals and Patients results from the contributions and hard work of many people. Its development was led by Dr Hai-Rim Shin, Coordinator, and Dr Warrick Junsuk Kim, Medical Officer, of the Noncommunicable Diseases and Health Promotion unit at the WHO Regional Office for the Western Pacific (WHO/WPRO/NCD) in Manila, Philippines. WHO graciously acknowledges the intellectual contributions of Dr Jung-jin Cho, Co-director, Community-based Primary Care Project Committee and Professor, Department of Family Medicine, Hallym University Sacred Heart Dongtan Hospital, Republic of Korea; Dr Hyejin Lee, Volunteer, WHO/WPRO/NCD (currently PhD candidate, Department of Family Medicine, Seoul National University, Republic of Korea); Ms Saki Narita, Volunteer, WHO/WPRO/NCD (currently PhD candidate, Department of Global Health Policy, Graduate School of Medicine, University of Tokyo, Japan); and Mr Byung Ki Kwon, Technical Officer, WHO/WPRO/NCD (currently Director, Division of Health Promotion, Ministry of Health and Welfare, Republic of Korea). Many thanks to Dr Albert Domingo, Dr Sonia McCarthy, Ms Marie Clem Carlos, Dr Katrin Engelhardt, Mr Kelvin Khow Chuan Heng and Dr Roberto Andres Ruiz from the WHO Regional Office for the Western Pacific and Dr Ma. Charina Benedicto, Physician-in-Charge, Bagong Barangay Health Center & Lying-in Clinic, Pandacan, Manila, Philippines for reviewing the draft publication. Financial support for this publication was received from the Korea Centers for Disease Control and Prevention, Republic of Korea. -
Risk Factors and Complications in Type 2 Diabetes Outpatients
RISKORIGINAL FACTORS AND COMPLICATIONS ARTICLE IN TYPE 2 DIABETES OUTPATIENTS Risk factors and complications in type 2 diabetes outpatients ELLEN FERNANDES FLávIO SILVA1, CRISTIANE MARIA MENDES FERREIRA2*, LUCINEIA DE PINHO3 1Medical Student, Faculdades Unidas do Norte de Minas (Funorte), Montes Claros, MG, Brazil 2Endocrinologist, Universidade Estadual de Montes Claros (Unimontes), Montes Claros, MG, Brazil 3PhD in Health Sciences, Unimontes and Funorte, Montes Claros, MG, Brazil SUMMARY Objective: Our study investigated type 2 diabetes mellitus (T2DM) outpatients attending a university hospital in Montes Claros, MG, to estimate the prevalence of risk factors and their association with diabetes complications. Method: This was a quantitative, documental, retrospective and analytical study. Medical records of 95 outpatients with T2DM treated in this hospital from 2011 to 2015 were analyzed. Data were collected according to a structured questionnaire surveying sociodemographic, anthropometric and biochemical data and clinical and lifestyle aspects. Regression analysis was used to evaluate the association between risk factor variables and complications. Results: With a mean age of 54 years, the study population showed irregular blood glucose control, despite the use of hypoglycemic medication, and did not Study conducted at Universidade have a healthy lifestyle. The main complication reported was high blood pressure Estadual de Montes Claros (Unimontes), Montes Claros, MG, Brazil (HBP), occurring in 70.9% of patients. The prevalence of complications was positively associated with patients receiving insulin treatment (p=0.042) and Article received: 11/13/2016 Accepted for publication: 12/19/2016 multidisciplinary monitoring (p=0.050). Conclusion: The associations identified reflect the condition of patients that *Correspondence: Address: Av. Dr. -
Dynamic External Pelvimetry Test in Third Trimester Pregnant Women: Shifting Positions Affect Pelvic Biomechanics and Create More Room in Obstetric Diameters
Open Access Original Article DOI: 10.7759/cureus.13631 Dynamic External Pelvimetry Test in Third Trimester Pregnant Women: Shifting Positions Affect Pelvic Biomechanics and Create More Room in Obstetric Diameters Marco Siccardi 1, 2 , Cristina Valle 3, 4 , Fiorenza Di Matteo 2 1. Obstetrics and Gynecology, Primal Osteopathy Institute, Savona, ITA 2. Obstetrics and Gynecology, San Paolo Hospital, Savona, ITA 3. Obstetrics and Gynaecology, San Paolo Hospital, Savona, ITA 4. Yoga and Cranial Osteopathy, Primal Osteopathy Institute, Savona, ITA Corresponding author: Marco Siccardi, [email protected] Abstract Dystocia in labor is still a clinical challenge. The "contracted pelvis" is the absence of pelvic mobility, which leads to fetal-pelvic disproportion, obstructed labor, and operative delivery. Maternal pelvis biomechanics studies by high technological techniques have shown that maternal shifting positions during pregnancy and labor can create more room in the pelvis for safe delivery. The external and internal pelvic diameters are related. The present study aims to evaluate the external obstetric pelvic diameters in shifting positions using a clinical technique suitable for daily practice in every clinical setting: the dynamic external pelvimetry test (DEP test). Seventy pregnant women were recruited, and the obstetric external pelvic diameters were measured, moving the position from kneeling standing to "hands-and-knees" to kneeling squat position. Results showed modification of the pelvic diameters in shifting position: the transverse and longitudinal diameters of Michaelis sacral area, the inter-tuberosities diameter, the bi-trochanters diameter, and the external conjugate widened; the bi-crestal iliac diameter, the bi-spinous iliac diameter, and the base of the Trillat's triangle decreased. -
World Journal of Hepatology
World Journal of W J H Hepatology Submit a Manuscript: https://www.f6publishing.com World J Hepatol 2020 June 27; 12(6): 288-297 DOI: 10.4254/wjh.v12.i6.288 ISSN 1948-5182 (online) ORIGINAL ARTICLE Retrospective Cohort Study Hospital teaching status on the outcomes of patients with esophageal variceal bleeding in the United States Pavan Patel, Laura Rotundo, Evan Orosz, Faiz Afridi, Nikolaos Pyrsopoulos ORCID number: Pavan Patel Pavan Patel, Faiz Afridi, Nikolaos Pyrsopoulos, Division of Gastroenterology and Hepatology, (0000-0001-5682-4939); Laura Rutgers - New Jersey Medical School, Newark, NJ 07101-1709, United States Rotundo (0000-0002-4094-3682); Evan Orosz (0000-0003-2474-5501); Laura Rotundo, Evan Orosz, Department of Medicine, Rutgers - New Jersey Medical School, Faiz Afridi (0000-0002-0172-0486); Newark, NJ 07101-1709, United States Nikolaos Pyrsopoulos (0000-0002-6950-8174). Corresponding author: Nikolaos Pyrsopoulos, FACP, MD, PhD, Chief Doctor, Professor, Division of Gastroenterology and Hepatology, Rutgers – New Jersey Medical School, 185 S. Author contributions: Patel P Orange Avenue, MSB H-535, Newark, NJ 07101-1709, United States. provided conception and design of [email protected] the study, acquisition and analysis of data, and drafting of the manuscript; Rotundo L, Afridi F and Orosz E drafted the manuscript; Pyrsopoulos N Abstract contributed to the manuscript by BACKGROUND providing revision and oversight Acute variceal bleeding is a major complication of portal hypertension and is a of its writing. leading cause of death in patients with cirrhosis. There is limited data on the Institutional review board outcomes of patients with esophageal variceal bleeding in teaching versus statement: This study did not nonteaching hospitals. -
Cervical Insufficiency
Cervical Insufficiency Sonia S. Hassan, MD 1,4 , Roberto Romero, MD 1,2,3 , Francesca Gotsch, MD 5, Lorraine Nikita, RN 1, and Tinnakorn Chaiworapongsa, MD 1,4 1Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD and Detroit, MI, USA; 2Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA; 3Department of Epidemiology, Michigan State University, East Lansing, Michigan, USA., 4Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA, 5Department of Obstetrics and Gynecology Azienda Ospedaliera Universitaria Integrata Verona, Italy 1 Introduction The uterine cervix has a central role in the maintenance of pregnancy and in normal parturition. Preterm cervical ripening may lead to cervical insufficiency or preterm delivery. Moreover, delayed cervical ripening has been implicated in a prolonged latent phase of labor at term. This chapter will review the anatomy and physiology of the uterine cervix during pregnancy and focus on the diagnostic and therapeutic challenges of cervical insufficiency and the role of cerclage in obstetrics. Anatomy The uterus is composed of three parts: corpus, isthmus and cervix. The corpus is the upper segment of the organ and predominantly contains smooth muscle (myometrium). The isthmus lies between the anatomical internal os of the cervix and the histological internal os, and during labor, gives rise to the lower uterine segment. The anatomical internal os refers to the junction between the uterine cavity and the cervical canal, while the histologic internal os is the region where the epithelium changes from endometrial to endocervical.1 The term “fibromuscular junction” was introduced by Danforth, who identified the boundary between the connective tissue of the cervix and the myometrium. -
N35.12 Postinfective Urethral Stricture, NEC, Female N35.811 Other
N35.12 Postinfective urethral stricture, NEC, female N35.811 Other urethral stricture, male, meatal N35.812 Other urethral bulbous stricture, male N35.813 Other membranous urethral stricture, male N35.814 Other anterior urethral stricture, male, anterior N35.816 Other urethral stricture, male, overlapping sites N35.819 Other urethral stricture, male, unspecified site N35.82 Other urethral stricture, female N35.911 Unspecified urethral stricture, male, meatal N35.912 Unspecified bulbous urethral stricture, male N35.913 Unspecified membranous urethral stricture, male N35.914 Unspecified anterior urethral stricture, male N35.916 Unspecified urethral stricture, male, overlapping sites N35.919 Unspecified urethral stricture, male, unspecified site N35.92 Unspecified urethral stricture, female N36.0 Urethral fistula N36.1 Urethral diverticulum N36.2 Urethral caruncle N36.41 Hypermobility of urethra N36.42 Intrinsic sphincter deficiency (ISD) N36.43 Combined hypermobility of urethra and intrns sphincter defic N36.44 Muscular disorders of urethra N36.5 Urethral false passage N36.8 Other specified disorders of urethra N36.9 Urethral disorder, unspecified N37 Urethral disorders in diseases classified elsewhere N39.0 Urinary tract infection, site not specified N39.3 Stress incontinence (female) (male) N39.41 Urge incontinence N39.42 Incontinence without sensory awareness N39.43 Post-void dribbling N39.44 Nocturnal enuresis N39.45 Continuous leakage N39.46 Mixed incontinence N39.490 Overflow incontinence N39.491 Coital incontinence N39.492 Postural -
Nitric Oxide in Human Uterine Cervix: Role in Cervical Ripening
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Helsingin yliopiston digitaalinen arkisto Department of Obstetrics and Gynecology Helsinki University Central Hospital University of Helsinki, Finland NITRIC OXIDE IN HUMAN UTERINE CERVIX: ROLE IN CERVICAL RIPENING Mervi Väisänen-Tommiska Academic Dissertation To be presented by permission of the Medical Faculty of the University of Helsinki for public criticism in the Auditorium of the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmanninkatu 2, Helsinki, on January 27, 2006, at noon. Helsinki 2006 Supervised by Professor Olavi Ylikorkala, M.D., Ph.D. Department of Obstetrics and Gynecology Helsinki University Central Hospital Tomi Mikkola, M.D., Ph.D. Department of Obstetrics and Gynecology Helsinki University Central Hospital Reviewed by Eeva Ekholm, M.D., Ph.D. Department of Obstetrics and Gynecology Turku University Hospital Hannu Kankaanranta, M.D., Ph.D. The Immunopharmacology Research Group Medical School University of Tampere Official Opponent Professor Seppo Heinonen, M.D., Ph.D. Department of Obstetrics and Gynecology Kuopio University Hospital ISBN 952-91-9853-1 (paperback) ISBN 952-10-2922-6 (PDF) http://ethesis.helsinki.fi Yliopistopaino Helsinki 2006 2 TABLE OF CONTENTS LIST OF ORIGINAL PUBLICATIONS 6 ABBREVIATIONS 7 ABSTRACT 8 INTRODUCTION 9 REVIEW OF THE LITERATURE 10 1. NITRIC OXIDE...................................................................................................................... 10 1.1 SYNTHESIS 10 1.2 AS A MEDIATOR 12 1.3 ASSESSMENT 12 1.4 GENERAL EFFECTS 13 1.5 IN REPRODUCTION 13 2. CERVICAL RIPENING......................................................................................................... 16 2.1 CONTROL 17 2.2 ASSESSMENT 19 2.3 INDUCTION 19 Misoprostol 19 Mifepristone 20 2.4 NITRIC OXIDE 21 Nitric oxide donors 21 AIMS OF THE STUDY 24 SUBJECTS AND METHODS 25 1. -
Postpartum Care of Taiwanese and Chinese Immigrant Women
City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 2-2017 Retelling an Old Wife’s Tale: Postpartum Care of Taiwanese and Chinese Immigrant Women Kuan-Yi Chen The Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/1872 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] RETELLING AN OLD WIFE’S TALE: POSTPARTUM CARE OF TAIWANESE AND CHINESE IMMIGRANT WOMEN by KUAN-YI CHEN A dissertation submitted to the Graduate Faculty in Sociology in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York 2017 © 2017 Kuan-Yi Chen All Rights Reserved ii Retelling an old wife’s tale: Postpartum care of Taiwanese and Chinese immigrant women by Kuan-Yi Chen This manuscript has been read and accepted for the Graduate Faculty in Sociology in satisfaction of the dissertation requirement for the degree of Doctor of Philosophy ______________________ _____________________________________ Date Barbara Katz Rothman Chair of Examining Committee ______________________ _____________________________________ Date Philip Kasinitz Executive Officer Supervisory Committee: Barbara Katz Rothman Margaret M. Chin Robert Courtney Smith THE CITY UNIVERSITY OF NEW YORK iii ABSTRACT Retelling an old wife’s tale: Postpartum care of Taiwanese and Chinese immigrant women by Kuan-Yi Chen Advisor: Barbara Katz Rothman The focus of this dissertation is the Chinese postpartum tradition zuoyuezi, often translated into English as doing-the-month. -
Clinical, Pathologic and Pharmacologic Correlations 2004
HUMAN REPRODUCTION: CLINICAL, PATHOLOGIC AND PHARMACOLOGIC CORRELATIONS 2004 Course Co-Director Kirtly Parker Jones, M.D. Professor Vice Chair for Educational Affairs Department of Obstetrics and Gynecology Course Co-Director C. Matthew Peterson, M.D. Professor and Chief Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology 1 Welcome to the course on Human Reproduction. This syllabus has been recently revised to incorporate the most recent information available and to insure success on national qualifying examinations. This course is designed to be used in conjunction with our website which has interactive materials, visual displays and practice tests to assist your endeavors to master the material. Group discussions are provided to allow in-depth coverage. We encourage you to attend these sessions. For those of you who are web learners, please visit our web site that has case studies, clinical/pathological correlations, and test questions. http://medstat.med.utah.edu/kw/human_reprod 2 TABLE OF CONTENTS Page Lectures/Examination................................................................................................................................... 4 Schedule........................................................................................................................................................ 5 Faculty .......................................................................................................................................................... 8 Groups ......................................................................................................................................................... -
Management of Prolonged Decelerations ▲
OBG_1106_Dildy.finalREV 10/24/06 10:05 AM Page 30 OBGMANAGEMENT Gary A. Dildy III, MD OBSTETRIC EMERGENCIES Clinical Professor, Department of Obstetrics and Gynecology, Management of Louisiana State University Health Sciences Center New Orleans prolonged decelerations Director of Site Analysis HCA Perinatal Quality Assurance Some are benign, some are pathologic but reversible, Nashville, Tenn and others are the most feared complications in obstetrics Staff Perinatologist Maternal-Fetal Medicine St. Mark’s Hospital prolonged deceleration may signal ed prolonged decelerations is based on bed- Salt Lake City, Utah danger—or reflect a perfectly nor- side clinical judgment, which inevitably will A mal fetal response to maternal sometimes be imperfect given the unpre- pelvic examination.® BecauseDowden of the Healthwide dictability Media of these decelerations.” range of possibilities, this fetal heart rate pattern justifies close attention. For exam- “Fetal bradycardia” and “prolonged ple,Copyright repetitive Forprolonged personal decelerations use may onlydeceleration” are distinct entities indicate cord compression from oligohy- In general parlance, we often use the terms dramnios. Even more troubling, a pro- “fetal bradycardia” and “prolonged decel- longed deceleration may occur for the first eration” loosely. In practice, we must dif- IN THIS ARTICLE time during the evolution of a profound ferentiate these entities because underlying catastrophe, such as amniotic fluid pathophysiologic mechanisms and clinical 3 FHR patterns: embolism or uterine rupture during vagi- management may differ substantially. What would nal birth after cesarean delivery (VBAC). The problem: Since the introduction In some circumstances, a prolonged decel- of electronic fetal monitoring (EFM) in you do? eration may be the terminus of a progres- the 1960s, numerous descriptions of FHR ❙ Complete heart sion of nonreassuring fetal heart rate patterns have been published, each slight- block (FHR) changes, and becomes the immedi- ly different from the others. -
Reproductive Medicine
Article Type: Commentary Reproductive medicine: still more ART than science? J Wilkinson1, S Bhattacharya2, JMN Duffy3,4, MS Kamath5, J Marjoribanks6, S Repping7, A Vail1, M van Wely7, CM Farquhar6 1 Centre for Biostatistics, University of Manchester, Manchester, United Kingdom. 2 The Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, United Article Kingdom. 3 Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom. 4 Balliol College, University of Oxford, Oxford, United Kingdom. 5 Reproductive Medicine Unit, Christian Medical College, Vellore, India. 6 Cochrane Gynecology and Fertility Group, University of Auckland, Auckland, New Zealand. 7 Centre for Reproductive Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands. This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/1471-0528.15409 Accepted This article is protected by copyright. All rights reserved. Corresponding author: J Wilkinson Centre for Biostatistics, University of Manchester, Manchester, United Kingdom. [email protected] Running title: Reproductive medicine: still more ART than science? Article The history of obstetrics and gynaecology is not a tale of evidence-based practice. Tradition, expert opinion, and the lure of new technology have frequently superseded evidence as the primary driver for clinical decision making 1. The proof can be found in a litany of dubious interventions which have gained widespread popularity despite an absence of high quality data attesting to their effectiveness and, in some cases, ample credible evidence demonstrating harm.