Abstracts – 2008 - Obstetricia Crítica

Department of Family Medicine, McMaster University, Hamilton, Ontario,Canada. shawea@mcmaster.caPURPOSE OF REVIEW: The postpartum period is a time of significantemotional, social, and physical change for most women. This review focuses onrecent evidence supported by systematic reviews and randomized, controlledtrials to guide the care of postpartum women who are otherwise healthy.RECENT FINDINGS: Mental health outcomes are improved with postpartumsupport in at-risk women. Postpartum depression can be treated eitherpharmacologically or with counseling; however, exercise and omega-3 fatty acidsare emerging as potentially effective alternatives. Intrauterine devices are safeand effective methods of contraception in the postpartum period. There has yetto be an effective, postpartum, smoking-cessation program developed, althoughintensive motivational counseling shows some promising early results. Bladderdysfunction continues to be a significant problem for women even at 10 yearspostpartum. Pelvic floor muscle exercises can help prevent and treatincontinence at 12 months, but longer-term follow-up studies are needed.Prevalence studies suggest that bowel dysfunction is common in the postpartumperiod, but randomized, controlled trials are limited to treatment in women withthird-degree perineal damage. SUMMARY: Although some recommendationscan be made for evidence-based postpartum care, many important questionsrelated to the postpartum period have not been examined by rigorousmethodologies.N Engl J Med. 2008 Feb 21;358(8):852; author reply 852-3.Comment on:N Engl J Med. 2007 Nov 29;357(22):2277-84.Computed tomography and radiation exposure.Varnholt H.Am J Obstet Gynecol. 2008 Mar;198(3):297.e1-7.Advanced extrauterine pregnancy: diagnostic and therapeutic challenges.Worley KC, Hnat MD, Cunningham FG.Department of Obstetrics and Gynecology, University of Texas SouthwesternMedical Center, Dallas, TX 75390-9032, USA. kworle@parknet.pmh.orgOBJECTIVE: The objective of the study was to identify women with advancedextrauterine pregnancy, specifically assessing the problems encountered withtheir diagnosis and management, preoperative evaluation, and surgical removal.STUDY DESIGN: This was a case series including women diagnosed with anextrauterine pregnancy of 18 weeks' gestation or greater at our institution from1980 to 2005. RESULTS: We identified 10 women with advanced extrauterinepregnancies during the study period. Diagnosis was not optimal, and only 6 werediscovered preoperatively. Despite the fact that only 3 of 10 women metdiagnostic criteria for an abdominal pregnancy, surgical dissection wasuniversally difficult, and hemorrhage was common with 9 of 10 patients requiringblood transfusions. In 2 women, the placenta was left in situ, and both developedserious complications. All 5 viable fetuses survived, but their courses were long