tailieunhanh - Critical Care Obstetrics part 38

Critical Care Obstetrics part 38 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | The Acute Abdomen During Pregnancy short-term as well as long-term 8 outcomes is promising higher-quality studies level I are eagerly awaited. If laparoscopic surgery is to be performed after the first trimester open laparoscopy is recommended to best avoid trocar or Veress needle injury to the gravid uterus. The use of a uterine manipulator is contraindicated in pregnancy. Magnetic resonance imaging MRI uses magnets that alter the energy state of hydrogen protons instead of using ionizing radiation. Though there has been no reported adverse fetal effect from its use current FDA labeling of MRI devices states that fetal safety has not been established. Although the elective use of MRI during pregnancy should be avoided its use is preferable to CT. Diagnostic i maging during pregnancy There is often concern over the use of diagnostic imaging during pregnancy. Organogenesis occurs predominately during days 31 through 71 from the last menstrual period. According to the American College of Radiology no single diagnostic X-ray procedure results in enough radiation exposure to threaten the well-being of the developing pre-embryo embryo or fetus. Radiation exposure of less than 5 rad is not associated with an increased risk of teratogenesis. However carcinogenesis is thought to be associated with ionizing radiation at higher doses 5 rad and the avoidance of unnecessary radiological testing is a valid concern. Ultrasound uses sound waves rather than ionizing radiation and is considered safe during pregnancy. At the time of this writing there are no reports of adverse fetal effects from its use. Therefore it should be considered a first-line diagnostic procedure if appropriate for the suspected condition. All diagnostic X-ray procedures result in fetal exposure of less than 5 rad Table . These range from approximately 100 mrad for a single view abdominal film to 2-4 rad for a barium enema or small bowel series. The amount of radiation exposure is largely dependent upon

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