ABSTRACT
When medical management of PPH is unsuccessful, surgical options should be utilized in a timely fashion in order to reduce maternal morbidity and mortality. This chapter describes ways of effective preparation, mobilization of resources and an organized approach to evaluation and surgical amelioration of PPH. Multiple fertility preserving surgical techniques to control PPH are described. Although a variety of conservative surgical approaches can be used in the setting of PPH, in a hemodynamically unstable patient, readiness for definitive management with a hysterectomy is necessary in order to reduce the risk of maternal mortality.
Subject(s)
Fertility Preservation/methods , Hysterectomy/methods , Postpartum Hemorrhage/surgery , Uterine Artery Embolization/methods , Uterus/surgery , Female , Guidelines as Topic , Humans , Organ Sparing Treatments , Patient Selection , PregnancyABSTRACT
OBJECTIVE: We sought to explore the clinical variables associated with the loss of rubella immunity during pregnancy and to determine if these changes are linked to obstetrical complications. METHODS: This is a case-control study in which women were identified whose rubella antibody titers were equivocal or non-immune and compared to those who had retained immunity. Two hundred and eighty-five cases were identified and compared to the same number of controls using Student's t test, Mann-Whitney U-test or Fisher's exact test. Univariate and multivariate logistic regressions were employed. RESULTS: Subjects with diminished immunity were more likely to have public insurance and higher gravidity with a trend toward increased tobacco use. Diminished rubella immunity was not associated with adverse obstetrical outcomes, including preterm birth and pre-eclampsia and is likely not a risk factor for these pregnancy outcomes. CONCLUSION: While no adverse pregnancy outcomes were associated with a loss of rubella immunity, women with greater number of pregnancies appear to lose their immunity to rubella. This relationship needs to be explored further and if proven, revaccination prior to pregnancy may need to be addressed.
Subject(s)
Pregnancy Complications/epidemiology , Pregnancy Complications/immunology , Pregnancy Outcome/epidemiology , Rubella virus/immunology , Rubella/epidemiology , Adult , Case-Control Studies , Female , Humans , Immunity , Infant, Newborn , Pre-Eclampsia/epidemiology , Pre-Eclampsia/immunology , Pregnancy , Premature Birth/epidemiology , Premature Birth/immunology , Rubella/immunology , Young AdultABSTRACT
OBJECTIVE: To estimate the effect of dose-dense chemotherapy during pregnancy on maternal and neonatal outcomes. METHODS: This is a retrospective cohort study in which women were identified from the international Cancer and Pregnancy Registry at Cooper Medical School at Rowan University in Camden, New Jersey. A chart analysis was completed and Fisher's exact test and independent t test were used in comparing patient outcomes. RESULTS: Ten women received dose-dense chemotherapy, received every 2 weeks, and 99 women received conventional chemotherapy, received with at least 3-week intervals, for breast cancer during pregnancy. Birth weight, gestational age at delivery, rate of growth restriction, congenital anomalies, and incidence of maternal and neonatal neutropenia were not statistically different between the two groups. CONCLUSION: In the small cohort of women in our registry, dose-dense chemotherapy does not appear to increase the risk of fetal or maternal complications.
