1/9. Perinatal bereavement support service: three-year review.Perinatal loss and grief have been recognized as a special form of loss in the last ten years. Perinatal death includes miscarriage, therapeutic abortion, stillbirth, and infant death shortly after birth. Acknowledgement of the death and support to mourn their loss by significant others promotes resolution of this bereavement. If perinatal bereavement is not resolved, one-quarter to one-third of mothers may go on to develop a clinical depression. A multidisciplinary Perinatal Support Service is in place at women's College Hospital to provide grief counselling to the mother and her family who have experienced a stillbirth or neonatal loss. The service has a direct link to the community through the public health Nurse on the obstetrical service. A review of three years reveals a high rate of referral by the attending physician and obstetrical nurse.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. The recognition and significance of the vanishing twin.With the advent of sonography, a twin pregnancy may be diagnosed in early gestation. Serial sonographic examinations can show the disappearance of one of two twins. We offer evidence of an early twin pregnancy with a "vanishing twin," resulting in a liveborn singleton plus a fetus papyraceus. There is an increasing body of information about explanations, management, and complications associated with a multiple gestation and fetal death. The distinction between monochorionic and dichorionic twins is important in their management and for both maternal and fetal prognosis. Identification of dizygotic twins through chromosomal or sonographic studies, revealing separate placentas, separate membranes, or different sexes, theoretically allows the physician to predict a favorable outcome for the live twin and the mother.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Maternal deaths associated with antepartum fetal death in utero, united states, 1972 to 1978.Little is known about the overall incidence of fetal death in utero (FDIU) in the united states or about the risks associated with its management. To address these questions, this study provides nationwide incidence data and reviews nine deaths of women with FDIU in the united states from 1972 to 1978. The crude death-to-case rate associated with FDIU is at least 4.5 deaths per 100,000 cases (95% confidence limits, 2.1 to 8.5). Existing information from comparative studies is inadequate to evaluate the comparative safety of different methods of evacuating the uterus after FDIU occurs at different gestational ages. Management of such cases should be determined by both the experience of the physician with uterine evacuation techniques and the medical and psychologic needs of the woman.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. Aggressive intrapartum management of lethal fetal anomalies: beyond fetal beneficence.OBJECTIVE: To evaluate management recommendations from the current literature for patients whose fetuses are certain to have lethal anomalies or absent (or virtually absent) cognitive function. These recommendations include termination of pregnancy or, for cases in the third trimester, nonaggressive intrapartum management, avoiding cesarean delivery for fetal indications. methods: We report our experience with several patients who voiced opposition to nonaggressive intrapartum care and present a rationale for selectively aggressive, intrapartum management for some of these cases. RESULTS: Four women whose fetuses had lethal anomalies requested aggressive intrapartum management. For three of the four, standard aggressive management of labor resulted in vaginal delivery of live-born infants who died shortly thereafter. The patients found comfort in the live births. The fourth patient accepted a recommendation to avoid fetal monitoring during labor, and the fetus was stillborn. This patient found the intrapartum experience to be very stressful. CONCLUSION: When a patient's desire to avoid an intrapartum stillbirth is strong enough that substantial psychological harm might result from one, the physician's beneficence-based obligation to her and respect for maternal autonomy justify selectively aggressive intrapartum therapy, even if no beneficence-based obligation to the fetus exists.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. pregnancy complicated by primary antiphospholipid antibody syndrome.BACKGROUND: Primary antiphospholipid antibody syndrome is a clinical entity that may threaten the health of both fetus and mother. CASE: We report a fatal case of primary antiphospholipid antibody syndrome in a woman who developed catastrophic disease due to multisystem thrombosis in the postpartum period following a fetal death. Three years before her admission, primary antiphospholipid antibody syndrome was diagnosed on the basis of high titers of immunoglobulin g anticardiolipin antibody, a positive lupus anticoagulant, a false-positive VDRL, and fibrin deposits in the biopsy of a palmar lesion. CONCLUSION: The physician must recognize the potentially catastrophic complications of pregnancy and the postpartum period in patients with antiphospholipid antibodies, and appropriate patient counseling should be provided.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. Use of ultrasonography for the evaluation of pregnant trauma patients.The expeditious diagnosis and management of the pregnant trauma patient is essential for the survival of both the mother and fetus. The rapid trauma ultrasound examination, which has been accurately utilized by trauma surgeons and emergency physicians, may have a tremendous impact on the timely identification of acute intraperitoneal injuries and, potentially, on the evaluation of fetal viability in the pregnant trauma patient. This report describes our experience with the rapid trauma ultrasound examination in the management of three pregnant trauma patients and outlines the potential advantages and limitations of the procedure.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Fatal spontaneous rupture of a gravid uterus: case report and literature review of uterine rupture.Spontaneous uterine rupture is a life-threatening obstetrical emergency encountered infrequently in the emergency department. The diagnosis of spontaneous uterine rupture is often missed or delayed, leading to maternal and fetal mortality. Emergency physicians must consider this diagnosis when presented with a pregnant patient in shock with abdominal pain. We present the case of a 38-year-old gravid female who presented to the emergency department in cardiac arrest 24 hours after an initial complaint of abdominal pain. We review the uterine rupture literature with specific focus on risk factors, signs and symptoms, diagnosis, treatment, and outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. hellp syndrome and cholecystitis: case report and review of the literature.A case of the hellp syndrome is reported that was initially diagnosed as cholecystitis. Much overlap exists between the two diagnoses, and the emergency physician must be aware of the important differences between them. Because the hellp syndrome and preeclampsia may occur in both the second and third trimesters, they represent serious diagnoses that must be considered when evaluating a pregnant patient with right upper quadrant abdominal pain.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. Delaying surgery for thyroid cancer in pregnancy. A case report.BACKGROUND: Management of thyroid cancer in pregnancy is controversial, as evidenced by disagreement in recommendations cited in leading obstetrics textbooks. Most thyroid carcinomas are well differentiated and pursue an indolent course. Many physicians recommend delay in surgical therapy until after delivery because of operative morbidity. CASE: A 27-year-old primigravida was found to have a solitary thyroid nodule at her initial obstetrics appointment. Fine needle aspiration was consistent with papillary carcinoma. Although detected at 8 weeks' estimated gestational age (EGA), the decision was made to defer surgical therapy until postpartum. The patient was referred to a tertiary care facility at 24 weeks' EGA secondary to rapid growth of the nodule. Surgery performed at that time revealed invasive disease. CONCLUSION: review of the literature suggests that delay in definitive therapy stems from early reports of fetal loss related to surgery, but contemporary data suggest that the risk of fetal loss related to surgery is minimal.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |