ISSN:1040-872X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Spontaneous vaginal delivery without obstetric intervention remains the goal for most pregnant women. Midwives and obstetricians aim to support women in achieving this result, which is associated with the lowest risk of morbidity for both mother and baby. Despite the best efforts of the labouring woman and her carers, some women will fail to progress in the second stage of labour, and obstetric intervention will be required. This review evaluates recent data addressing the diagnosis, aetiology and management of failure to progress in the second stage of labour, and explores aspects of maternal and neonatal morbidity associated with this event.

ISSN:1040-872X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Obstetric morbidity is an important marker of the quality of obstetric care. This review explores the definition, incidence and significance of obstetric morbidity. Some topical issues related to obstetric morbidity are discussed. In addition, the importance of long-term morbidity and violence against women is highlighted.

ISSN:1040-872X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Pulmonary thromboembolism is the leading cause of maternal death in the UK. Optimal management of deep venous thrombosis and pulmonary thromboembolism requires an appreciation of risk factors, particularly thrombophilia, and signs or symptoms suggestive of venous thromboembolism, along with objective diagnosis and treatment with anticoagulants. Low molecular weight heparins are now replacing unfractionated heparin for the treatment of deep venous thrombosis and pulmonary thromboembolism in pregnancy because of the lower risk of side effects, ease of administration and reduced need for monitoring.

ISSN:1040-872X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Misoprostol, an orally active prostaglandin E1 analogue, has been used widely by the vaginal and oral routes for labour induction at or near term. Several recent trials have confirmed that it is highly effective. Overall caesarean section rates appear to be reduced, despite a relative increase in caesarean sections for fetal heart rate abnormalities. Concern remains regarding increased rates of uterine hyperstimulation and meconium-stained amniotic fluid, although data on perinatal outcomes have been reassuring. Recent reports reviewed here have raised the possibility that postpartum haemorrhage may be increased after the induction of labour with misoprostol, and isolated reports of uterine rupture with or without previous caesarean section, continue to appear. Using small dosages appears to reduce adverse outcomes. Very large trials are needed to evaluate rare adverse outcomes.

ISSN:1040-872X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Epidural and spinal analgesia for pain relief in labour are now commonplace. Adverse effects such as hypotension and toxicity to anaesthetic agents are well described and easily managed. The effects on obstetric outcome, however, have been unclear to both obstetricians and anaesthetists, but are important due to the large number of pregnancies involved. Efforts to define implications for mother and child have been frustrated by a relative lack of evidence derived from good quality, large randomized trials. Ethical and methodological difficulties together with an abundance of confounding factors have conspired to cause considerable difficulties for researchers in this area. Nevertheless, recent evidence has significantly advanced knowledge in the field and has implications for future practice.

ISSN:1040-872X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Three to four percent of singleton pregnancies at term are complicated by breech presentation. The management options are to offer external cephalic version, to perform planned caesarean section or to aim for vaginal birth. There has been an increasing reluctance, in many centres, to allow vaginal birth. The publication of the Term Breech Trial will almost certainly accelerate this trend. For many, the choice now lies between external cephalic version and elective caesarean section. Perhaps the focus should now be on increasing the rate of offering external cephalic version, increasing its uptake and also its success.

ISSN:1040-872X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Postpartum haemorrhage remains in the top five causes of maternal deaths in both developed and developing countries. Persistent blood loss of more than 1000 ml should prompt predetermined measures to achieve resuscitation and haemostasis. A protocol including guidelines is given and volume replacement is discussed. The range of medical and surgical interventions that may be considered for the modern management of major haemorrhage unresponsive to oxytocin and ergometrine are presented. The review discusses in depth the use of misoprostol, recombinant activated factor VII, the uterine tamponade procedures, artery ligation, and uterine haemostatic suturing techniques. It also evaluates the place of interventional radiology and hysterectomy in modern obstetrics.

ISSN:1040-872X    

出版商:OVID    

年代:2001

数据来源: OVID

摘要:

Postnatal depression is a major public health problem affecting about one in seven women after childbirth. Depression is also common during pregnancy and throughout the perinatal period it is associated with symptoms of anxiety. Apart from the adverse consequences for women themselves becoming depressed when they are going through demanding physical and social changes, there are additional concerns. There is the possible negative impact of maternal depression on the relationship between mother and child and on the child's emotional, behavioural and cognitive development. Primary prevention and early intervention/secondary prevention strategies are potentially important in view of the frequent contact pregnant women, new mothers and infants have with health services, but the effectiveness of these strategies needs to be tested. In the past year there have been five new studies of antenatal screening for postnatal depression. These studies are consistent with nine earlier studies in showing that there is no evidence to support routine antenatal screening for postnatal depression. Seven new primary prevention/early intervention trials add evidence on a wide range of interventions ranging from practical support to individual interpersonal therapy, but without identifying significant differences in depression as an outcome. Two new trials of secondary prevention, one involving interpersonal therapy and the other including partners in a series of psychoeducational visits, show promise but neither is large enough to form a basis for practice change. Novel interventions, or promising findings, with a strong basis in theory need to be tested in trials which are appropriately sized and which comply with internationally accepted design and reporting guidelines.

ISSN:1040-872X    

出版商:OVID    

年代:2001

数据来源: OVID

ISSN:1040-872X    

出版商:OVID    

年代:2001

数据来源: OVID