Disseminated intravascular coagulation causes: Difference between revisions

Jump to navigation Jump to search
No edit summary
 
(16 intermediate revisions by 7 users not shown)
Line 1: Line 1:
__NOTOC__
__NOTOC__
{{Template:DIC}}
{{Template:DIC}}
{{CMG}}; {{AE}} {{Ochuko}}
{{CMG}}; {{AE}} {{Ochuko}} {{OK}}


==Overview==
==Overview==
There are a variety of causes of DIC<ref>{{cite book |last = Ledingham | first = J | coauthors = D Warrell | title = Concise Oxford Textbook of Medicine | publisher = Oxford University Press | date = 2000 | isbn = 0-19-262870-4,}}</ref>, all usually causing the release of chemicals into the blood that instigates the coagulation.
There are a variety of causes of [[DIC]], all usually causing the release of [[chemicals]] into the [[blood]] that instigates the [[coagulation]]. Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. [[Disseminated intravascular coagulation]] in itself is a life-threatening condition and must be treated as such irrespective of the cause. Common causes include [[abruptio placentae]], [[amniotic fluid embolism]], [[aortic aneurysm]], [[blood transfusion]] reaction, drugs (e.g. [[Amphetamines]]), beractant [[eclampsia]], giant [[hemangioma]], [[graft-versus-host disease]], [[HELLP syndrome]] and hemolytic transfusion reaction.


==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.  
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.<ref name="pmid6773170">{{cite journal |vauthors=Spero JA, Lewis JH, Hasiba U |title=Disseminated intravascular coagulation. Findings in 346 patients |journal=Thromb. Haemost. |volume=43 |issue=1 |pages=28–33 |date=February 1980 |pmid=6773170 |doi= |url=}}</ref>


Disseminated intravascular coagulation in itself is a life-threatening condition and must be treated as such irrespective of the cause.
Disseminated intravascular coagulation in itself is a life-threatening condition and must be treated as such irrespective of the cause.<ref name="pmid19222477">{{cite journal |vauthors=Levi M, Toh CH, Thachil J, Watson HG |title=Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology |journal=Br. J. Haematol. |volume=145 |issue=1 |pages=24–33 |date=April 2009 |pmid=19222477 |doi=10.1111/j.1365-2141.2009.07600.x |url=}}</ref><ref name="pmid18066597">{{cite journal |vauthors=Ghosh K, Shetty S |title=Blood coagulation in falciparum malaria--a review |journal=Parasitol. Res. |volume=102 |issue=4 |pages=571–6 |date=March 2008 |pmid=18066597 |doi=10.1007/s00436-007-0832-0 |url=}}</ref><ref name="pmid580488">{{cite journal |vauthors=Siegal T, Seligsohn U, Aghai E, Modan M |title=Clinical and laboratory aspects of disseminated intravascular coagulation (DIC): a study of 118 cases |journal=Thromb. Haemost. |volume=39 |issue=1 |pages=122–34 |date=February 1978 |pmid=580488 |doi= |url=}}</ref>


===Common Causes===
===Common Causes===
Line 17: Line 17:
*[[Aortic aneurysm]]
*[[Aortic aneurysm]]
*[[transfusion reaction|Blood transfusion reaction]]
*[[transfusion reaction|Blood transfusion reaction]]
*[[Drugs]] (e.g. [[Amphetamines]])
*[[Drugs]] (e.g. [[Amphetamines]]), [[Beractant]]
*[[Eclampsia]]
*[[Eclampsia]]
*[[hemangioma|Giant hemangioma]]
*[[hemangioma|Giant hemangioma]]
Line 34: Line 34:
===Causes by Organ System===
===Causes by Organ System===


{|style="width:80%; height:100px" border="1"
{| style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
| style="width:25%" bgcolor="LightSteelBlue" ; border="1" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Aortic aneurysm]], [[Malignant hypertension]], [[Myocardial infarction]], [[Septic shock]], [[Shock]], [[Vasculitis]]
| style="width:75%" bgcolor="Beige" ; border="1" | [[Aortic aneurysm]], [[malignant hypertension]], [[myocardial infarction]], [[septic shock]], [[shock]], [[vasculitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Snake bite]]
| bgcolor="Beige" | [[snake bite|Snake bite (elapid)]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dermatologic'''
| '''Dermatologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Purpura fulminans]], [[Raynaud's disease]], [[rheumatoid arthritis]], [[vasculitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Amphetamine]], [[Cocaine]], [[Interleukin 2]], [[Serotonin syndrome]]
| bgcolor="Beige" | [[Amphetamine]], [[cocaine]], [[indomethacin]], [[interleukin 2]], [[Mafenide]], [[serotonin syndrome]], [[Dinoprostone]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
| '''Ear Nose Throat'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-  
|-  
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Environmental'''
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Acute fatty liver of pregnancy]], [[Acute hepatic failure]], [[Acute pancreatitis]], [[Crohn disease]], [[Liver disease]], [[Ulcerative colitis]]
| bgcolor="Beige" | [[Acute fatty liver of pregnancy]], [[hepatic failure|acute hepatic failure]], [[acute pancreatitis]], [[Crohn disease]], [[hepatic failure|fulminant hepatic failure]], [[liver disease]], [[ulcerative colitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''Hematologic'''
|bgcolor="Beige"| [[Paroxysmal nocturnal hemoglobinuria]], [[Purpura fulminans]], [[Acute myeloid leukemia]], [[Acute promyelocytic leukemia]]
| bgcolor="Beige" | [[transfusion reaction|Acute hemolytic transfusion reactions]], [[acute myeloid leukemia]], [[acute promyelocytic leukemia]],  [[antiphospholipid syndrome]], [[Kasabach-Merritt syndrome]], [[myeloproliferative syndrome]], [[paroxysmal nocturnal hemoglobinuria]], [[purpura fulminans]], [[Trousseau's syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Iatrogenic'''
| '''Iatrogenic'''
|bgcolor="Beige"| [[Acute renal allograft rejection]], [[Blood transfusion and complications]], [[Denver shunt]], [[Extensive surgery]], [[LeVeen shunt]], [[Peritoneovenous shunt]], [[Prosthetic devices]], [[Recent anesthesia]], [[Reperfusion after liver transplantation]], [[Ventricular assist devices]]
| bgcolor="Beige" | [[transplant rejection|Acute renal allograft rejection]], [[Denver shunt]], [[surgery|extensive surgery]], [[LeVeen shunt]], [[liver transplantation]], [[peritoneovenous shunt]], [[prosthetic devices]], [[serotonin syndrome]], [[surgery]], [[anesthesia|recent anesthesia]], [[ventricular assist devices]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Infectious Disease'''
| '''Infectious Disease'''
|bgcolor="Beige"| [[Argentine hemorrhagic fever]], [[Aspergillosis]], [[Bolivian Hemorrhagic Fever]], [[Capnocytophaga canimorsus]], [[CMV]], [[Hepatitis viruses]], [[Histoplasmosis]], [[Malaria (malignant tertian)]], [[Meningococcal septicaemia]], [[Mycoplasma pneumoniae]], [[Neisseria meningiditis]], [[Neisseria meningitidis]], [[Osteomyelitis]], [[Rocky mountain spotted fever]], [[Sarcoidosis]], [[Sleeping sickness (East African)]], [[Streptococcus pneumoniae]], [[Tuberculosis]], [[Typhoid fever]], [[Viral hemorrhagic fevers]], [[VZV]], [[Septic shock]]
| bgcolor="Beige" | [[arenavirus|Arenaviruses]], [[Argentine hemorrhagic fever]], [[aspergillosis]], [[hemorrhagic fever|Bolivian hemorrhagic fever]], [[capnocytophaga canimorsus]], [[CMV]], [[HELLP syndrome]], [[hepatitis|hepatitis viruses]], [[histoplasmosis]], [[malaria|malaria (malignant tertian)]], [[meningococcemia|meningococcal septicaemia]], [[mycoplasma pneumoniae]], [[neisseria meningiditis]], [[osteomyelitis]], [[rocky mountain spotted fever]], [[sarcoidosis]], [[sepsis]], [[septic shock]], [[African trypanosomiasis|sleeping sickness (East African)]], [[streptococcus pneumoniae]], [[tuberculosis]], [[typhoid fever]], [[hemorrhagic fever|viral hemorrhagic fevers]], [[VZV]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Osteomyelitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Antiphospholipid syndrome]], [[meningococcemia|meningococcal septicaemia]], [[neisseria meningiditis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Amniotic fluid embolism]], [[Eclampsia]], [[HELLP syndrome]], [[Intrauterine death]], [[Placental abruption]], [[Pre-eclampsia]], [[Retained intrauterine fetal demise]]
| bgcolor="Beige" | [[Abruptio placentae]], [[amniotic fluid embolism]], [[dead fetus syndrome]], [[eclampsia]], [[HELLP syndrome]], [[intrauterine death]], [[pre-eclampsia]], [[retained intrauterine fetal demise]], [[septic abortion]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| [[Acute myeloid leukemia]], [[Acute promyelocytic leukemia]], [[Cancers of lung, pancreas, prostate and stomach]], [[Giant hemangioma]], [[Kasabach-Merritt syndrome]], [[Mucin-secreting adenocarcinoma]], [[Myeloproliferative syndromes]], [[Paraneoplastic syndrome]], [[Trousseau's syndrome]]
| bgcolor="Beige" | [[Acute myeloid leukemia]], [[acute promyelocytic leukemia]], [[carcinoma|Cancers of lung, pancreas, prostate and stomach]], [[hemangioma|giant hemangioma]], [[Kasabach-Merritt syndrome]], [[malignancy]], [[mucin|mucin-secreting adenocarcinoma]], [[paraneoplastic syndrome]], [[Trousseau's syndrome]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Opthalmologic'''
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Amphetamine]], [[cocaine]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Psychiatric'''
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| [[Empyema]]
| bgcolor="Beige" | [[Acute respiratory distress syndrome]], [[empyema]], [[mycoplasma pneumoniae]], [[sarcoidosis]], [[streptococcus pneumoniae]], [[tuberculosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | [[Renal failure]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Antiphospholipid syndrome]], [[Macrophage activation syndrome]], [[Raynaud disease]], [[Rheumatoid arthritis]]
| bgcolor="Beige" | [[transplant rejection|Acute  renal allograft rejection]], [[antiphospholipid  syndrome]], [[interleukin 2]], [[macrophage-activation syndrome]], [[paraneoplastic  syndrome]], [[Raynaud's disease]], [[rheumatoid arthritis]], [[sarcoidosis]], [[vasculitis]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Sexual'''
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| [[Burns]], [[Crush syndrome]], [[Head injury]], [[Lightning strike]], [[Motor vehicle accidents]], [[Severe tissue injury]]
| bgcolor="Beige" | [[Burns]], [[crush syndrome]], [[head injury]], [[electrical injury|lightning strike]], [[motor vehicle accidents]], [[soft tissue injury|severe tissue injury]], [[trauma]]
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Urologic'''
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Dental'''
| '''Dental'''
|bgcolor="Beige"| No underlying causes
| bgcolor="Beige" | No underlying causes
|-
|-
|-bgcolor="LightSteelBlue"
|- bgcolor="LightSteelBlue"
| '''Miscellaneous'''
| '''Miscellaneous'''
|bgcolor="Beige"| [[Heat stroke]]
| bgcolor="Beige" | [[Heat stroke]], [[hyperthermia]], [[prosthetic devices]], [[snake bite|Snake bite (elapid)]], [[venomous snake|venomous snakes]]
|-
|-
|}
|}
Line 244: Line 244:


==References==
==References==
{{Reflist|2}}
{{reflist|2}}


[[Category:Hematology]]
[[Category:Cardiology]]
{{WS}}
{{WH}}
{{WH}}
{{WS}}

Latest revision as of 14:25, 30 August 2018

Disseminated intravascular coagulation Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Disseminated intravascular coagulation from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

Echocardiograph and Ultrasound

CT

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Disseminated intravascular coagulation causes On the Web

Most recent articles

cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Disseminated intravascular coagulation causes

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Disseminated intravascular coagulation causes

CDC on Disseminated intravascular coagulation causes

Disseminated intravascular coagulation causes in the news

Blogs on Disseminated intravascular coagulation causes

Directions to Hospitals Treating Disseminated intravascular coagulation

Risk calculators and risk factors for Disseminated intravascular coagulation causes

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2] Omer Kamal, M.D.[3]

Overview

There are a variety of causes of DIC, all usually causing the release of chemicals into the blood that instigates the coagulation. Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Disseminated intravascular coagulation in itself is a life-threatening condition and must be treated as such irrespective of the cause. Common causes include abruptio placentae, amniotic fluid embolism, aortic aneurysm, blood transfusion reaction, drugs (e.g. Amphetamines), beractant eclampsia, giant hemangioma, graft-versus-host disease, HELLP syndrome and hemolytic transfusion reaction.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.[1]

Disseminated intravascular coagulation in itself is a life-threatening condition and must be treated as such irrespective of the cause.[2][3][4]

Common Causes

Causes by Organ System

Cardiovascular Aortic aneurysm, malignant hypertension, myocardial infarction, septic shock, shock, vasculitis
Chemical / poisoning Snake bite (elapid)
Dermatologic Purpura fulminans, Raynaud's disease, rheumatoid arthritis, vasculitis
Drug Side Effect Amphetamine, cocaine, indomethacin, interleukin 2, Mafenide, serotonin syndrome, Dinoprostone
Ear Nose Throat No underlying causes
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic Acute fatty liver of pregnancy, acute hepatic failure, acute pancreatitis, Crohn disease, fulminant hepatic failure, liver disease, ulcerative colitis
Genetic No underlying causes
Hematologic Acute hemolytic transfusion reactions, acute myeloid leukemia, acute promyelocytic leukemia, antiphospholipid syndrome, Kasabach-Merritt syndrome, myeloproliferative syndrome, paroxysmal nocturnal hemoglobinuria, purpura fulminans, Trousseau's syndrome
Iatrogenic Acute renal allograft rejection, Denver shunt, extensive surgery, LeVeen shunt, liver transplantation, peritoneovenous shunt, prosthetic devices, serotonin syndrome, surgery, recent anesthesia, ventricular assist devices
Infectious Disease Arenaviruses, Argentine hemorrhagic fever, aspergillosis, Bolivian hemorrhagic fever, capnocytophaga canimorsus, CMV, HELLP syndrome, hepatitis viruses, histoplasmosis, malaria (malignant tertian), meningococcal septicaemia, mycoplasma pneumoniae, neisseria meningiditis, osteomyelitis, rocky mountain spotted fever, sarcoidosis, sepsis, septic shock, sleeping sickness (East African), streptococcus pneumoniae, tuberculosis, typhoid fever, viral hemorrhagic fevers, VZV
Musculoskeletal / Ortho Osteomyelitis
Neurologic Antiphospholipid syndrome, meningococcal septicaemia, neisseria meningiditis
Nutritional / Metabolic No underlying causes
Obstetric/Gynecologic Abruptio placentae, amniotic fluid embolism, dead fetus syndrome, eclampsia, HELLP syndrome, intrauterine death, pre-eclampsia, retained intrauterine fetal demise, septic abortion
Oncologic Acute myeloid leukemia, acute promyelocytic leukemia, Cancers of lung, pancreas, prostate and stomach, giant hemangioma, Kasabach-Merritt syndrome, malignancy, mucin-secreting adenocarcinoma, paraneoplastic syndrome, Trousseau's syndrome
Opthalmologic No underlying causes
Overdose / Toxicity Amphetamine, cocaine
Psychiatric No underlying causes
Pulmonary Acute respiratory distress syndrome, empyema, mycoplasma pneumoniae, sarcoidosis, streptococcus pneumoniae, tuberculosis
Renal / Electrolyte Renal failure
Rheum / Immune / Allergy Acute renal allograft rejection, antiphospholipid syndrome, interleukin 2, macrophage-activation syndrome, paraneoplastic syndrome, Raynaud's disease, rheumatoid arthritis, sarcoidosis, vasculitis
Sexual No underlying causes
Trauma Burns, crush syndrome, head injury, lightning strike, motor vehicle accidents, severe tissue injury, trauma
Urologic No underlying causes
Dental No underlying causes
Miscellaneous Heat stroke, hyperthermia, prosthetic devices, Snake bite (elapid), venomous snakes

Causes in Alphabetical Order

References

  1. Spero JA, Lewis JH, Hasiba U (February 1980). "Disseminated intravascular coagulation. Findings in 346 patients". Thromb. Haemost. 43 (1): 28–33. PMID 6773170.
  2. Levi M, Toh CH, Thachil J, Watson HG (April 2009). "Guidelines for the diagnosis and management of disseminated intravascular coagulation. British Committee for Standards in Haematology". Br. J. Haematol. 145 (1): 24–33. doi:10.1111/j.1365-2141.2009.07600.x. PMID 19222477.
  3. Ghosh K, Shetty S (March 2008). "Blood coagulation in falciparum malaria--a review". Parasitol. Res. 102 (4): 571–6. doi:10.1007/s00436-007-0832-0. PMID 18066597.
  4. Siegal T, Seligsohn U, Aghai E, Modan M (February 1978). "Clinical and laboratory aspects of disseminated intravascular coagulation (DIC): a study of 118 cases". Thromb. Haemost. 39 (1): 122–34. PMID 580488.
  5. 5.0 5.1 5.2 5.3 5.4 Lurie S, Feinstein M, Mamet Y (2000). "Disseminated intravascular coagulopathy in pregnancy: thorough comprehension of etiology and management reduces obstetricians' stress". Arch Gynecol Obstet. 263 (3): 126–30. PMID 10763841.


Template:WS Template:WH