By Ronald S. Gibbs, Beth Y. Karlan, Arthur F. Haney, Ingrid E. Nygaard

Obstetricia y ginecología de Danforth ha sido durante forty años una obra de referencia primary para residentes y médicos de estas especialidades. En esta 10.ª edición se han revisado y reorganizado por completo los contenidos a fin de proporcionar una guía completa y fiable de l. a. práctica clínica moderna en obstetricia y ginecología. Se ha añadido un apartado sobre uroginecología y nuevos capítulos sobre mortinalidad y trastornos psicológicos durante el embarazo y el puerperio.

Características Principales:

  • Incluye casos clínicos
  • Resúmenes de conceptos básicos al principio de cada capítulo  
  • Más algoritmos y tablas

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Extra info for Ginecologia Danforth's Obstetrics and Gynecology

Sample text

Antepartum factors and intrapartum factors Meconium Meconium passage prior to birth occurs in up to 20% of term deliveries and is a common reason for neonatal resuscitation. In the 1970s it was recognized that early suctioning by the obstetrician or pediatrician decreased the incidence of meconium aspiration syndrome (MAS). In the 1980s, routine suctioning of the oropharynx at the perineum or endotracheal suctioning were standard practice; however, it became clear that not all cases of MAS could be prevented and that aspiration in utero could occur.

Bilirubin peaks at 5 days in formula-fed infants but may peak as late as 7 to 10 days in breast-fed infants. Breast milk production is minimal in the first 48 hours after delivery and does not reach 80% of full volume until 4 days postpartum. Because of this time frame, it is not easy to predict at 3 days of age which breast-fed infants with a negative Coombs test will be at risk of dangerously high bilirubin levels (>25 mg/dL), and it is nearly impossible to do so at less than 48 hours. In recognition of these issues, the pendulum appears to be swinging back to a 3-day stay for most breast-fed infants.

Renewed pushing by the mother in combination with gentle upward traction by the obstetrician will achieve delivery of the posterior shoulder. The baby's body generally delivers easily following the shoulders. Care must be taken to support the baby's head and ensure that the baby does not slip from one's grip. After confirmation of good respiration and normal heart rate (easily checked at the cord insertion at the umbilicus), the baby may be given to the mother to cradle. The cord is then double-clamped and cut, and cord blood collected.

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