Schwartz's Principles of Surgery, 9e
|Part II. Specific Considerations >|
Surgical Conditions of the Obstetric Patient
Sections: Surgical Conditions
of the Obstetric Patient, Procedures Performed
before Viability, Amniocentesis/Chorionic
Villus Sampling, Pregnancy Terminations, Cerclage, Ectopic Pregnancies, Procedures Performed
after Viability, Obstetric Lacerations
and Repair, Cesarean Deliveries, Peripartum Hysterectomy, Gestational
Topics Discussed: abortion, induced; amniocentesis; bladder; caesarean section low transverse; cerclage, cervical; cesarean section; chorionic villi sampling; classical cesarean section; critical care obstetrics; ectopic pregnancy; extraperitoneal cesarean section; gestational trophoblastic disease; gestational trophoblastic neoplasms; gynecologic diseases; hydatidiform mole; hysterectomy; hysterectomy, cesarean; malignant gestational trophoblastic neoplasia; obstetric lacerations; obstetric surgical procedures; pregnancy, physiologic alterations in; pregnancy, tubal; prenatal care; repair of episiotomy; ureter; uterine blood flow.
Excerpt:"Many women will undergo invasive diagnostic procedures for prenatal
diagnosis. Between 0.2 and 2.2% of pregnant women will
require surgery in pregnancy for issues both related and unrelated
to the pregnancy.2326 Another 25 to 30% will
have cesarean deliveries,27 increasing the risks
for associated or subsequent emergency hysterectomies
with future pregnancies. Although these procedures typically are
performed by obstetricians and gynecologists, occasionally a general
surgeon will be consulted for assistance with postoperative or intraoperative
issues. Physiologic changes due to pregnancy should be kept in mind
(Table 41-5).23Prenatal genetic diagnosis typically requires obtaining fetal
tissue or cells. While newer techniques using maternal blood are
currently being evaluated, the traditional methods for obtaining
fetal genetic material are amniocentesis and chorionic villus sampling.
Chorionic villus sampling is typically performed between 10 to 12
weeks gestation by using ultrasound to guide a flexible catheter
transcervically into the trophoblastic tissue surrounding the
gestational sac. An amniocentesis is performed after about 13 weeks
gestation by ultrasound-associated guidance..."
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