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Thursday, December 31, 2009

Down Syndrome - High Risk Mothers And Early Detection By Anne Clarke

As an expecting mother, please be sure to keep all doctor's appointments, take all prenatal vitamins and dietary supplements, and be absolutely certain to begin taking care of your child from the moment you find out you're pregnant. Prenatal care is essential for any expecting mother. Down Syndrome, as a primary concern for pregnant women over the age of 35, or for women genetically predisposed to give birth to a child with this condition, can sometimes be detected as early as the first trimester. Please see your doctor regularly and as soon as possible for an ultrasound.
Although there is not much that advanced medicine, as of yet, can do to prevent this troubling disease, there are ways a woman can prepare herself and her family to care for a child with Down Syndrome. This, of course, applies to many pregnancies and potential birth defects, such as Trisomy-18 and other chromosomal abnormalities that may occur. Taking care of yourself while you are pregnant is the most important thing you can do.
Any pregnancy is important, and many variables are certainly worth attending to during those crucial months before your child is born. Whether it has already been determined that yours is a high-risk pregnancy, or if you may possibly be a high-risk pregnancy, even if (as far as you know) you and your baby are in perfect health, medical attention is essential from the earliest possible point in your pregnancy.
One very important thing to do, in addition to all other prenatal care, is to have an ultra-screen done in your first trimester. An ultra-screen is a procedure that has been extensively studied. Screening is recommended for all pregnant patients, not just women over the age of 35. Of all Down Syndrome pregnancies, 91 percent can be detected by use of an ultra-screen in the first trimester. There is, however, a five percent chance of getting a false-positive result, therefore, if the first ultra screen is positive, reschedule another to be sure. If the screening detects a Trisomy-18 defect it is likely to be accurate. The false-positive rate on the ultra screen for Trisomy-18 is more like one percent. The ultra screen can detect, incredibly early, the chances of Trisomy-18 with up to 98 percent accuracy.
So, some of you eager expecting mothers are probably wondering, how exactly is the ultra-screen test performed? A combination ultrasound and blood test are keys to this procedure and the accuracy of its results. According to experts who routinely use the equipment, "the test begins with an ultrasound examination between 11w1d and 13w6d gestation." The CRL needs to be between 45 and 84 mm. CRL is measured for accurate pregnancy dating (i.e. the date of conception) and nuchal translucency (NT) is measured as well before the procedure can be performed. NT is a specific marker for chromosomal aneuploidy which can be detected by this procedure. At the time of the ultrasound exam, the doctors will collect a dried blood sample via fingerstick.
Along with the dried blood sample taken, the ultrasound data is entered onto the test requisition form and sent to laboratories for complete analysis. The blood sample is screened for free Beta HCG and Plasma Protein A(PAPP-A), a pregnancy-associated plasma protein. The risk for Down Syndrome in the fetus as well as the risk for Trisomy-18 are calculated based on the patent's age, the nuchal translucency, as well as the freebeta and PAPP-A. Despite the medical jargon that is sometimes difficult to get around, get the ultra-screen in your first trimester, and ask your doctor specific questions no matter how much you don't understand. The number one objective is to understand as much as you possibly can when it comes to your unborn child.
Anne Clarke writes numerous articles for Web sites on gardening, parenting, fashion, and home decor. Her background also includes health and fitness. For more of her useful articles on pregnancy and breastfeeding, please visit Breast Pumps, supplier of breastfeeding information and supplies.

Friday, December 25, 2009

Polycystic Ovary Syndrome

 Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a disorder characterized by hyperandro-
genism, ovulatory dysfunction, and polycystic ovaries. Its etiology remains
unknown, and treatment is largely symptom based and empirical. PCOS has the
potential to cause substantial metabolic sequelae, including an increased risk of
diabetes and cardiovascular disease,and these factors should be considered when
determining long-term treatment. The purpose of this document is to examine the
best available evidence for the diagnosis and clinical management of PCOS.
Background
Incidence, Definition, and Diagnostic Criteria
There is no universally accepted definition of PCOS and expert generated diag-
nostic criteria have proliferated in recent years (see Table 1). The Rotterdam cri-
teria, which supplanted the National Institutes of Health (NIH) diagnostic
criteria (1),incorporated the appearance of the ovary based on ultrasound exam-
ination into the schema (2). Ultrasound criteria for the diagnosis of polycystic
ovaries were decided by expert consensus (see Box 1) (3). These criteria have
been criticized for including more mild phenotypes, which increases the preva-
lence of PCOS and may complicate treatment decisions. The Androgen Excess
Society (AES) criteria recognizes hyperandrogenism as a necessary diagnostic
factor, in combination with other symptoms of the syndrome (4). Hyperandro-
genism can be established on the basis of clinical findings (eg, hirsutism or
acne) or serum hormone measurement. All diagnostic approaches recommend
that secondary causes (such as adult-onset congenital adrenal hyperplasia,
hyperprolactinemia,and androgen-secreting neoplasms) should first be excluded.
All diagnostic schemes also require more than one sign or symptom (Table 1,
Box 3). Polycystic ovaries alone,for example,are a nonspecific finding and also
are frequently noted in women with no endocrine or metabolic abnormalities.



ACOG JOURNAL

Wednesday, December 23, 2009

Pacquiao Vs Mayweather

Pacquiao Vs Mayweather

While we are watching their preparation before their match, now we got another suprising news.
Mayweather requesting for a drug thest for both of them, so there will be no question about it.
But why now? Why the other challenger og Pacquiao never requested this before?
Some people react that it was not necessary, esspecially the request come from the challenger.
Is this request makes senses?

he request by Floyd Mayweather for both he and Manny Pacquiao to potentially be blood tested as close as 48 hours from their possible March superfight is both unprecedented and unnecessary.


Pacquiao’s de facto manager told Yahoo! Sports’ Kevin Iole that Pacman will be blood tested one month out and just after the possible March 13 fight in (likely) Las Vegas. That schedule should answer any possible doping questions about Pacquiao (or Mayweather). The 48-hour deadline is a classic Mayweather psychological ploy, a little edge designed to get into his opponent’s
hat said, at this point, with the debate this far along, Pacquiao should just suck it up and agree to it.
Mayweather is a master at putting opponents in bad positions, both inside and outside the ring. Pacquiao is in one now, outfoxed by Mayweather in the fight negotiations. There’s no way Pacquiao can explain walking away from one of the biggest bouts in boxing history because, as his promoter suggests, he’s afraid of needles.
Do that and it isn’t just the game of boxing that takes a beating – it’s also Pacquiao’s reputation. The semantics about boxing standards or steroid cycles or unfair negotiations won’t break through what would, no doubt, be a vocal hammering from critics, none louder than from the Mayweathers.
“For that kind of money, how could you not take a test?” Floyd’s father, Floyd Mayweather Sr., has already crowed to the Grand Rapids (Mich.) Press.
Indeed, how do you not take a test?
The Mayweather camp has been outspoken in its suspicions about Pacquiao and performance-enhancing drugs. So it demanded that both fighters possibly submit blood samples to the United States Anti-Doping Agency in the days before and after the fight. When to test would be up to USADA. Pacquiao’s promoter, Bob Arum, said they’d stick to State of Nevada regulations, although Pacquiao’s adviser, Michael Koncz, said they’d do blood samples, just not that close to the fight.
That isn’t good enough, so far, for the Mayweather camp. If no one budges, boxing may be in the process of shooting itself in the foot, walking away from an event that already has fans worldwide buzzing in anticipation. More likely: Something gets worked out in time for a fight announcement in early January.
“In a fight of this magnitude, I think it is our responsibility to subject ourselves to sportsmanship at the highest level,” Mayweather Jr. said in a statement.

Manny Pacquiao’s team, which includes promoter Bob Arum, left, and trainer Freddie Roach, has been put into a corner over needles and blood testing.


“We’re going in a different direction,” Arum told the Grand Rapids Press. “What I believe is that Floyd never really wanted the fight and this is just harassment of Pacquiao.”
There’s little doubt this is harassment of Pacquiao. What else would you expect from Floyd Mayweather? He’s the master at screwing with opponents. Making Pacquiao discuss PEDs in the run up to the fight is a potential distraction – even if he’s clean. That was, no doubt, a goal when his camp requested aggressive doping standards.
This isn’t Mayweather’s normal bluster, though. He’s on the moral high ground here. The Pacquiao camp can hate the situation it finds itself in and may be correct that the requests are mostly ridiculous. It doesn’t change the reality of the debate.
If Pacman pulls out of the fight because of the timetable for doping tests, he’ll have a near-impossible challenge proving he isn’t trying to hide something.
Arum isn’t doing Pacquiao any favors with some of his silly excuses. He said Pacquiao is squeamish about needles, which is a heck of a thing to blow up a contest to determine the toughest pound-for-pound fighter on the planet.
He added that Pacquiao thinks a blood test within 48 hours of the fight might drain him, although most such tests take very little actual blood. Then there’s Arum’s claim that every doctor in the world would say doing such a thing is “stupid” and blood tests don’t “prove anything.” That’s hyperbole.
“Manny Pacquiao doesn’t know anything about drugs,” Arum told the Grand Rapids paper. “This is just typical nastiness by wise guys like [Mayweather Promotions CEO Leonard] Ellerbe and Mayweather.”
Nastiness? Sure. Wise guys? Absolutely. The Mayweather camp doesn’t play around. However, to say we have to just take Arum’s word that Pacquiao doesn’t know anything about drugs is absurd. There hasn’t been a reason to believe anything or anyone in sports on this topic in years. PED scandals in baseball, football, cycling, track, swimming and so on aren’t Pacquiao’s fault, but that’s the sporting reality he lives in.
He can’t just pretend fan suspicion isn’t reasonable.

Floyd Mayweather Sr. has taken his shots against Pacquiao over the past year.
(Getty Images)
Pacquiao has been a breath of fresh air for boxing and he’s never failed a drug test in his 50-3-2 career. The chance to see a man of similar speed and skill finally challenge the unbeaten Mayweather (40-0) has reenergized the sport.
Which doesn’t mean either fighter is above reproach. The Mayweathers have had no problem voicing their concerns about Pacman’s ability to maintain punching power and punch-taking ability as he has climbed through weight classes (even as Mayweather has made a similar journey).
Regardless, in one of their typically deft maneuvers, they demanded extreme testing standards that left the Pacquiao camp backpedaling and debating an issue they can’t win.
What Mayweather is calling for may be unfair, but is Pacquiao going to give up tens of millions of dollars and a chance to cement his legacy as one of the all-time greatest fighters out of principle?
Is he going to bail knowing that he opens himself up to questions about PEDs because, despite being tough enough to let Miguel Cotto unload on him, he’s scared of a needle?
Floyd Mayweather has cornered him on this one, doing what he does best, making the fight get fought on his terms. The way to stop Mayweather, though, has always been to punch back – hard.
Instead, Manny Pacquiao is going to walk away?

Health Care Reform Bill Still Sparking Disputes

Health Care Reform Bill Still Sparking Disputes

Will this reformation will showed it result? I hope .......

What will it effect on most people??? Will it??

What do you think about this reformation? Please shared your opinion here.

Last night's vote in the Senate sent its watered-down version of health care reform on to the next step in the sausage-making process. And while reform advocates seemed to cheer the end result last night -- at least from my decidedly imperfect vantage, which was monitoring the vote via Twitter while standing on line for a cab at Union Station -- here on the morning after, plenty of divisions remain between those who want to propel this imperfect bill forward and those who want it scrapped.
Over at Firedoglake, Jane Hamsher doesn't see the Senate bill as either effective or the beginning of something effective: "The Senate bill isn't a 'starter home', it's a sink hole." Hamsher goes on to list the "Top 10 Reasons to Kill Senate Health Care Bill".
1. Forces you to pay up to 8% of your income to private insurance corporations -- whether you want to or not.
2. If you refuse to buy the insurance, you'll have to pay penalties of up to 2% of your annual income to the IRS.
3. Many will be forced to buy poor-quality insurance they can't afford to use, with $11,900 in annual out-of-pocket expenses over and above their annual premiums.
4. Massive restriction on a woman's right to choose, designed to trigger a challenge to Roe v. Wade in the Supreme Court.
5. Paid for by taxes on the middle class insurance plan you have right now through your employer, causing them to cut back benefits and increase co-pays.
6. Many of the taxes to pay for the bill start now, but most Americans won't see any benefits -- like an end to discrimination against those with preexisting conditions -- until 2014 when the program begins.
7. Allows insurance companies to charge people who are older 300% more than others.
8. Grants monopolies to drug companies that will keep generic versions of expensive biotech drugs from ever coming to market.
9. No re-importation of prescription drugs, which would save consumers $100 billion over 10 years.
10. The cost of medical care will continue to rise, and insurance premiums for a family of four will rise an average of $1,000 a year -- meaning in 10 years, your family's insurance premium will be $10,000 more annually than it is right now.
The Washington Post's Ezra Klein doesn't see it that way, and counters by saying that while the bill "that looks likely to clear the Senate this week is not very close to the health-care bill most liberals want... it is very close to the health-care bill that Barack Obama promised."
...there are, to be sure, some differences. The public option did not survive the Senate. The individual mandate, which Obama campaigned against, was added after key members of Congress and the administration realized that the plan wouldn't function in its absence. Drug reimportation was defeated, and a vague effort to have government pick up some catastrophic costs was never really mentioned.
But the basic structure of the proposal is remarkably similar. Here's how it was described in the campaign's white paper:
The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can't afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.
This is about where the debate is right now, with some willing to settle and other angry that the administration -- by not attempting to do more politicking in advance of last night's vote -- gave up too much. As I wrote last week, my main problems with the bill are that while it may comport to the campaign's white paper, it falls far short of the promises made on the campaign trail. That's why I suspect that the one thing the passage of a reconciled health care reform bill will not achieve is to end the need for substantial health care reform.

 

Monday, December 21, 2009

Cervical Cytology Screening

Cervical Cytology Screening
CLINICALMANAGEMENTGUIDELINESFOROBSTETRICIAN–GYNECOLOGISTS
NUMBER109, DECEMBER 2009
(Replaces Practice Bulletin Number 45, August 2003, Committee Opinion Number 300, October 2004, and Committee Opinion Number 431, May 2009)


The incidence of cervical cancer has decreased more than 50% in the past 30  years because of widespread screening with cervical cytology. In 1975,the rate was 14.8 per 100,000 women in the United States; by 2006,it had been reduced to 6.5 per 100,000 women. Mortality from the disease has undergone a similar decrease (1). The American Cancer Society estimates 11,270 new cases of cer-
vical cancer in the United States in 2009, with 4,070 deaths from the disease (2). Recent estimates worldwide,however,are of almost 500,000 new cases and 240,000 deaths from the disease per year (3). When cervical cytology screening programs have been introduced into communities,marked reductions in cervical cancer incidence have followed (4–6). New technology for performing cervical cancer screening is evolving rapidly, as are recommendations for classifying and interpreting the results. The purpose of this document is to provide a review of the best available evidence on screening for cervical cancer. Specific equipment and techniques for performing cervical cytology and interpretation of the results are not discussed.



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Wednesday, December 9, 2009

Posting again!!!

After a very busy month,
Thanks God we can finish all the exams and the accredititation.
Hope i can post a new joournal soon...
I forgot my rapidshare account hahahahahaha...

Wednesday, September 2, 2009

MEDICAL EBOOK DOWNLOAD, ACOG PRACTICE BULLETIN NUMBER 106, JULY 2009, Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles

MEDICAL EBOOK DOWNLOAD

ACOG PRACTICE BULLETIN NUMBER 106, JULY 2009

Intrapartum Fetal Heart Rate Monitoring: Nomenclature, Interpretation, and General Management Principles


DOWNLOAD:
Intrapartum_Fetal_Heart_Rate_Monitoring_Nomenclature__Interpretation__and_General_Management_Princip

In the most recent year for which data are available, approximately 3.4 million
fetuses (85% of approximately 4 million live births) in the United States were
assessed with electronic fetal monitoring (EFM), making it the most common
obstetric procedure (1). Despite its widespread use, there is controversy about
the efficacy of EFM, interobserver and intraobserver variability, nomenclature,
systems for interpretation, and management algorithms. Moreover, there is evidence
that the use of EFM increases the rate of cesarean deliveries and operative
vaginal deliveries. The purpose of this document is to review nomenclature
for fetal heart rate assessment, review the data on the efficacy of EFM, delineate
the strengths and shortcomings of EFM, and describe a system for EFM
classification.

MEDICAL EBOOK DOWNLOAD, American Journal of Obstetrics & Gynecology AUGUST 2009, The future of intrapartum care: navigating the perfect storm—an obstetrician’s odyssey

MEDICAL EBOOK DOWNLOAD

American Journal of Obstetrics & Gynecology AUGUST 2009

The future of intrapartum care: navigating the perfect storm—an obstetrician’s odyssey


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The_future_of_intrapartum_care_navigating_the_perfect_storm___an_obstetrician___s_odyssey.pdf

MEDICAL EBOOK DOWNLOAD, American Journal of Obstetrics & Gynecology AUGUST 2009, Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections

MEDICAL EBOOK DOWNLOAD

American Journal of Obstetrics & Gynecology AUGUST 2009

Safety of late second-trimester pregnancy termination by laminaria dilatation and evacuation in patients with previous multiple cesarean sections


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Safety_of_late_second-trimester_pregnancy_termination_by_laminaria_dilatation_and_evacuation_in_pati



OBJECTIVE: To assess whether there is an increased perioperative risk
in termination of late second-trimester pregnancy after multiple cesarean
sections by laminaria dilatation and evacuation.

STUDY DESIGN: During the period between January 2002 and June
2008, 636 consecutive patients underwent late second-trimester
(17-24 weeks) pregnancy terminations by dilatation and evacuation.
Patients were divided into 3 subgroups: those with no previous
cesarean section (n = 545), those with 1 previous cesarean
section (n = 59), and those with several previous cesarean sections
(n = 32).

RESULTS: There were no significant differences in major perioperative
complications, such as anesthetic complications, need for blood transfusion,
and cervical lacerations comparing the 3 subgroups. Importantly,
there were neither cases of uterine perforation nor retained products
of conception in the 3 subgroups.

CONCLUSION: Late second-trimester pregnancy termination after multiple
cesarean sections by laminaria dilatation and evacuation is probably
not associated with an increased perioperative risk. Larger studies
are needed to empower this study.

Key words: cesarean section, dilatation and evacuation, late
abortion, scarred uterus

MEDICAL EBOOK DOWNLOAD, American Journal of Obstetrics & Gynecology AUGUST 2009, Discontinuation of antihypertensive drug use during the first trimester of pregnancy and the risk of preeclampsia and eclampsia among women with chronic hypertension

 MEDICAL EBOOK DOWNLOAD

American Journal of Obstetrics & Gynecology AUGUST 2009


Discontinuation of antihypertensive drug use during the first trimester of pregnancy and the risk of preeclampsia and eclampsia among women with chronic hypertension

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Discontinuation_of_antihypertensive_drug_use_during_the_first_trimester_of_pregnancy_and_the_risk_of



OBJECTIVE: The goal of this study was to investigate the association
between the discontinuation of antihypertensive medication use during
the first trimester of pregnancy and the risk of preeclampsia and
eclampsia.

STUDY DESIGN: We conducted a nested case-control approach
within a cohort that was reconstructed from the linkage of 3 databases.
To be included in the study, women had to match the following
criteria: (1) between 15-45 years old on the first day of
gestation, (2) covered by Québec’s Drug Insurance Plan for at least
12 months before and during pregnancy, (3) exposed to an antihypertensive
drug on the first day of gestation, and (4) have had a delivery. Multivariate conditional logistic regression models were used to estimate the risk.

RESULTS: Adjusting for confounders, the odds ratio was 0.66; 95%
confidence interval, 0.27-1.56.

CONCLUSION: Our finding does not support the presence of a statistically
significant association between antihypertensive discontinuation
during the first trimester of pregnancy and the risk of
preeclampsia and eclampsia.

Key words: antihypertensive drug discontinuation, chronic
hypertension, eclampsia, preeclampsia, pregnancy

MEDICAL EBOOK DOWNLOAD, American Journal of Obstetrics & Gynecology AUGUST 2009, Uterine artery Doppler flow studies in obstetric practice

MEDICAL EBOOK DOWNLOAD 


American Journal of Obstetrics & Gynecology AUGUST 2009

Uterine artery Doppler flow studies in obstetric practice

DOWNLOAD:
Uterine_artery_Doppler_flow_studies_in_obstetric_practice.pdf

The advent of sonography has changed the practice of obstetrics by providing a window
to the womb through which the anatomic structure of the fetus can be evaluated. The
addition of Doppler flow studies of maternal and fetal vessels has provided a tool where
the physiology of the maternal-fetal unit can be assessed. This information can provide
the physician and the patient with vital information for a subsequent approach to the
pregnancy. The use of fetal Doppler blood flow studies has become common in the
evaluation and management of pregnancies complicated by conditions such as suspected
fetal growth restriction and red blood cell isoimmunization to guide intrauterine therapy
and delivery. The most commonly assessed Doppler flow studies of the fetus are the
umbilical artery and middle cerebral artery (MCA). Doppler flow studies of the MCA are
used in the assessment of the fetus at risk for anemia and growth-restricted fetus. Doppler
flow studies of the umbilical artery can reflect abnormalities in “down-stream” or the fetal
side of placental resistance, and the assessment of the maternal vasculature evaluates
“up-stream” blood flow or the maternal side of placental resistance. The purpose of this
review is to describe the clinical utility of uterine artery Doppler flow studies in the
prediction of adverse pregnancy outcomes in low and high risk populations.
Key words: Doppler, fetal growth restriction, middle cerebral artery, pregnancy

MEDICAL EBOOK DOWNLOAD, American Journal of Obstetrics & Gynecology AUGUST 2009, Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted infection

American Journal of Obstetrics & Gynecology AUGUST 2009,
Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted infection


DOWNLOAD:
Emergency_contraceptive_use_as_a_marker_of_future_risky_sex__pregnancy__and_sexually_transmitted_inf


OBJECTIVE: The objective of the study was to examine whether emergency
contraceptive use predicts future sex at risk for pregnancy, pregnancy,
or sexually transmitted infection among young women.

STUDY DESIGN: A secondary analysis of control group participants
(n:718) from a recent trial of advanced provision of emergency
contraception was conducted.

RESULTS: We found no association between use of emergency contraception
and either pregnancy or infection. Recent use predicted decreased
occurrence of subsequent sex at risk for pregnancy among
women with a history of sexually transmitted infection (relative risk
[RR], 0.39; 95% confidence interval [CI], 0.15-0.97), whereas ever
having used predicted increased occurrence among women who either
were highly effective method users (RR, 1.45; 95% CI, 1.05-2.01) or
had no history of sexually transmitted infection (RR, 1.31; 95% CI,
1.04-1.65).

CONCLUSION: Information about prior emergency contraceptive use
was not a useful predictor of subsequent pregnancy, infection, or sex at
risk for pregnancy among these young women.
Key words: adolescent, postcoital contraception, pregnancy,
reproductive health care, sexually transmitted infections

Cite this article as: Sander PM, Raymond EG, Weaver MA. Emergency contraceptive use as a marker of future risky sex, pregnancy, and sexually transmitted
infection. Am J Obstet Gynecol 2009;201:146.e1-6.

MEDICAL EBOOK DOWNLOAD,American Journal of Obstetrics Gynecology First-trimester maternal serum screening and the risk for fetal distress during labor

American Journal of Obstetrics & Gynecology
First-trimester maternal serum screening and the risk for fetal distress during labor

DOWNLOAD:
First-trimester_maternal_serum_screening_and_the_risk_for_fetal_distress_during_labor.pdf



Title: First-trimester maternal serum screening and the risk for fetal distress during labor
Source: American Journal of Obstetrics & Gynecology. 201(2):166e1-166e6, August 2009.
Abstract
OBJECTIVE: The purpose of this study was to assess whether low pregnancy-associated plasma protein-A (PAPP-A) levels in the first trimester are related to the risk of emergency cesarean section delivery (CS) for fetal distress during labor and fetal intrapartum acidemia.

STUDY DESIGN: We prospectively studied patients who requested first-trimester biochemical screening for Down syndrome.

RESULTS: Among the 1037 women who were enrolled, 152 women (14.7%) had a low first-trimester PAPP-A value, and 855 women (85.3%) had a normal first-trimester PAPP-A value. Excluding elective CS, 19 of 117 women (16.2%) with low PAPP-A values vs 59 of 749 women (7.9%) with normal PAPP-A values underwent CS for concerning fetal status during labor (P = .003; odds ratio, 2.27; 95% confidence interval, 1.30-3.97). This difference remained significant after correction for possible confounders (hypertension, preterm delivery, small for gestational age, labor induction). Among these 78 women, umbilical artery pH was significantly lower in fetuses from mothers with low vs normal PAPP-A values (pH = 7.19 [range, 6.95-7.39] vs pH = 7.26 [range, 7.02-7.39]; P = .022).

CONCLUSION: Low PAPP-A levels at first-trimester screening are associated independently with higher rates of emergency CS for nonreassuring fetal status during labor and lower pH.

(C) Mosby-Year Book Inc. 2009. All Rights Reserved.

Thursday, August 27, 2009

EBOOK DOWNLOAD, A Textbook of Postpartum Hemorrhage

A Textbook of Postpartum Hemorrhage
Publisher: Sapiens Publishing | Pages: 500 | 2006 | ISBN: 0955228212 | PDF | 19 MB
 
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The objective of this book is to bring together within a single volume the most up to date information about the epidemiology, diagnosis and management of postpartum hemorrhage. Whilst much has been published on the subject a truly comprehensive synthesis of this kind has never before been attempted. This volume sets out, therefore, to provide physicians with an overall clinical perspective that has hitherto been unavailable. The volume is essentially practical in orientation addressing specific issues that confront any obstetrician responsible for the management of postpartum hemorrhage. In particular it features new surgical techniques that have been shown to be markedly successful and straigh forward to apply, and which have clear advantages over emergency hysterectomy in many instances. Other important issues that are reviewed in detail include causation, prevention, therapy for atonic and non-atonic conditions, and long term consequenses Written by an international team of specially invited experts, this book should meet a genuine need. In particular it is hoped it will contribute in a practical way to management of postpartum hemorrhage in developing countries where scarcity of resources may be compounded by a lack of clinically reliable information about the last theraputic advances.

MEDICAL EBOOK

Medical ebook "Te Linde's Operative Gynecology 10th edition
DOWNLOAD:
Te_Linde_s_Operative_Gynecology_10th_Ed.chm

                                                                                   

Authors/editors: John A Rock and Howard W Jones III
ISBN: 978-0-7817-7234-1
Page count: 1449
Publisher: Lippincott
Publication year: 2008
The world's leading gynecologic surgery reference for 60 years, Te Linde's Operative Gynecology is now in its revised tenth edition. In this new edition, Te Linde's leads the field with bold initiative in its first attempt to synthesize the best way for surgical procedures. This classic text is rooted in the Johns Hopkins tradition of gynecologic surgery, but now includes 75 contributors, for a broader, more complete presentation of national and international practices. The book provides encyclopedic coverage of the etiology, diagnosis, and step-by-step surgical treatment of benign and malignant diseases and disorders of the female pelvis. More than 1,600 illustrations demonstrate the surgical techniques.
Table of contents:
Section I General Topics Affecting Gynecological Practice
1. Operative Surgery Before the Era of Laparoscopy: A Brief History
2. The Ethics of Pelvic Surgery
3. Psychological Aspects of Pelvic Surgery
4. Professional Liability and Risk Management for the Gynecological Surgeon
5. The Changing Environment in Which We Practice Gynecological Surgery
6. Training the Gynecological Surgeon
Section II Principles of Anatomy and Perioperative Considerations
1. Surgical Anatomy of the Female Pelvis
2. Preoperative Care
3. Postanesthesia and Postoperative Care
4. Water, Electrolyte and Acid-Base Metabolism
5. Postoperative Infections: Prevention and Management
6. Shock in the Gynecologic Patient
7. Wound Healing, Suture Material, and Surgical Instrumentation
Section III Principles of Gynecological Surgical Techniques and Management of Endoscopy
1. Incisions for Gynecological Surgery
2. Principles of Electrosurgery as Applied to Gynecology
3. Application of Laser Gynecology
4. Diagnostic and Operative Laparoscopy
5. Operative Hysteroscopy
6. Control of Pelvic Hemorrhage
Section IV Surgery for the Fertility
1. The Impact of Assisted Reproductive Technology on Gynecological Surgery
2. Reconstructive Tubal Surgery
3. Endometriosis
Section V Surgery for Benign Gynecologic Conditions
1. Surgical Conditions of the Vulva
2. Surgical Conditions of the Vagina and Urethra
3. Surgery for Anomalies of the Mullerian Ducts
4. Normal and Abnormal Uterine Bleeding
5. Tubal Sterilization
6. Surgery for Benign Disease of the Ovary
7. Persistent or Chronic Pelvic Pain
8. Pelvic Inflammatory Disease
9. Leiomyomata Uteri and Myomectomy
10. A - Abdominal Hysterectomy
11. B - Vaginal Hysterectomy
12. C - Laparoscopic Hysterectomy
Section VI Surgery for Obstetrics
1. Management of Abortion
2. Ectopic Pregnancy
3. A - Obstetric Problems
4. B - Ovarian Tumors Complicating Pregnancy
Section VII Surgery for Corrections of Defects in Pelvic Support and Pelvic Fistulas
1. A - Pelvic Organ Prolapse – Basic Principles
2. B - Site-Specific Repair of Cystourethrocele
3. C - Paravaginal Defect Repair
4. D - Posterior Compartment Defects
5. E - Vaginal Vault Prolapse
6. F - The Nonsurgical Management of Pelvic Organ Prolapse: The Use of Vaginal Pessaries
7. Stress Urinary Incontinence
8. Operative Injuries to the Ureter
9. Vesicovaginal Fistula and Urethrovaginal Fistula
10. Anal Incontinence and Rectovaginal Fistulas
Section VIII Related Surgery
1. Breast Diseases: Benign and Malignant
2. The Vermiform Appendix in Relation to Gynecology
3. Intestinal Tract in Gynecological Surgery
4. Nongynecologic Conditions Encountered by the Gynecologic Surgeon
Section IX Gynecologic Oncology
1. Malignancies of the Vulva
2. Cervical Cancer Precursors and Their Management
3. Cancer of the Cervix
4. Endometrial Cancer
5. Ovarian Cancer: Etiology, Screening, and Surgery
6. Pelvic Exenteration
7. Surgical Reconstruction of the Pelvis in Gynecologic Cancer Patients

Friday, August 21, 2009

Some journal connected to nonatal jaundice

Becouse there is a request already about nonatal jaundice, i already tried to find some journal in the ovid. But just found this:

Evaluation of Discharge Management in the Prediction of Hyperbilirubinemia: The Jerusalem
Experience
http://rapidshare.com/files/269865273/Evaluation_of_Discharge_Management_in_the_Prediction_of.pdf

Cytokines in Human Colostrum and Neonatal Jaundice
http://rapidshare.com/files/269865086/Cytokines_in_Human_Colostrum_and_Neonatal_Jaundice.pdf

Risk Factors for Severe Hyperbilirubinemia among Infants with Borderline
Bilirubin Levels: A Nested Case-Control Study
http://rapidshare.com/files/269864816/Risk_Factors_for_Severe_Hyperbilirubinemia_among_Infants.pdf

just a little bit lazy to find another journal, maybe next time, hehehehehe

ACOG Practice Bulletin NUMBER 107, AUGUST 2009

For the starter i want to shared a new ACOG (THE AMERICAN COLLEGE OF OBSTETRICIANS AND GYNECOLOGISTS) clinical management guidlines for obstetrician and gynecologist volume 107 August 2009 about induction of labor. Here you will find to manage labor induction, indication, regiment which they use for labor induction and their complication.
Hope this can help you a lot.

Here's the link:
http://www.ziddu.com/download/8122130/induction.pdf.html

MEDICAL EBOOK DOWNLOAD

Medical ebook download "Williams Gynecology"
 



Williams Gynecology By Schorge, John O, Schaffer, Joseph I., Halvorson, Lisa M., Hoffman, Barbara L., Bradshaw, Karen D, and Cunningham, F. Gary
The first guide to bridge the gap between medical and surgical gynecology
A Doody's Core Title
Written by clinicians from the same department of Obstetrics and Gynecology responsible for the landmark bestseller Williams Obstetrics, this full-color text and atlas offers a complete overview of gynecology that no other source can match. In its pages, you'll find a templated, in-depth examination of the entire spectrum of gynecologic disease.
Supporting this unparalleled coverage are a gynecologic surgical atlas, and numerous comprehension-building algorithms, tables, and figures that clarify differential diagnoses and preferred management strategies for treatment. And unlike most multi-authored texts, Williams Gynecology has a consistent, even tone, as all of its editors and authors are affiliated with Parkland Hospital in Dallas.
FEATURES:
  • Encyclopedic scope covers the full range of gynecologic disorders, from cancer and infertility, to urogynecologic disorders
  • Full-color atlas section consisting of 350 figures that illuminate operative surgical techniques -- created by the Director and students of the Biomedical Communications Graduate Program at UT Southwestern.
  • Strong procedure orientation, covering a wide array of surgical operations, which are illustrated in detail
  • Numerous clinical algorithms and boxes highlighting differential diagnoses and best-practice treatment methods
  • Experienced author team from Parkland Hospital that updated the classic Williams Obstetrics--the leading reference in obstetrics for more than a century
·         Author Biography
·         John O. Schorge, MD
Holder, Patricia Duniven Fletcher Professorship in Gynecologic Oncology
Director, Division of Gynecologic Oncology Fellowship Program
Associate Professor, Department of Obstetrics and Gynecology
University of Texas Southwestern Medical Center, Dallas
·         Joseph I. Schaffer, MD
Director, Division of Gynecology
Director, Division of Urogynecology and Female Pelvic Reconstructive Surgery
Professor, Department of Obstetrics and Gynecology
University of Texas Southwestern Medical Center, Dallas
Chief of Gynecology, Parkland Memorial Hospital, Dallas
·         Lisa M. Halvorson, MD
Director, Division of Reproductive Endocrinology and Infertility
Associate Professor, Department of Obstetrics and Gynecology
University of Texas Southwestern Medical Center, Dallas
·         Barbara L. Hoffman, MD
Assistant Director, Third-year Medical Student Clerkship
Assistant Professor, Department of Obstetrics and Gynecology
University of Texas Southwestern Medical Center, Dallas
·         Karen D. Bradshaw, MD
Holder, Helen J. and Robert S. Strauss and Diana K. and Richard C. Strass Distinguished Chairmanship in Women's Health
Director, Lowe Foundation Center for Women's Preventative Health Care
Associate Residency Program Director, Department of Obstetrics and Gynecology
Professor, Department of Obstetrics and Gynecology
Professor, Department of Surgery
University of Texas Southwestern Medical Center, Dallas
·         F. Gary Cunningham, MD
Holder, Beatrice & Miguel Elias Distinguished Chair in Obstetrics and Gynecology
Chairman Emeritus, Department of Obstetrics and Gynecology
Professor, Department of Obstetrics and Gynecology
University of Texas Southwestern Medical Center, Dallas