(Am J Obstet Gynecol. 2018;218:523.e1–523.e12)
While intrapartum electronic fetal monitoring (EFM) is commonly used and promises to reduce adverse neonatal outcomes by predicting acidemia, there is a lack of data regarding an association between EFM patterns and acidemia. This study aimed to assess EFM patterns and their association with acidemia and neonatal morbidity and determine which visually interpreted EFM patterns were associated with acidemia and neonatal morbidity.
(Am J Obstet Gynecol. 2016;215(3):310.e1–e7)
The main purpose of this nested case control study was to investigate a modern obstetric cohort in order to identify risk factors and develop prediction models for perineal lacerations and obstetric anal sphincter injuries (OASI, third and fourth degree lacerations) during vaginal delivery. In addition, this study also reevaluated the known risk factors in order to potentially identify new risk factors for any perineal laceration and OASI so as to determine the role of parity in the risk of sustaining any perineal laceration and OASI.
Background-Although oxytocin is commonly used to augment or induce labor, it is difficult to predict its effectiveness because oxytocin dose requirements vary significantly amongst women. One possibility is that women requiring high or low doses of oxytocin have variations in the oxytocin receptor gene.Objectives-This work aims to identify oxytocin receptor gene variants in laboring women with low and high oxytocin dosage requirements.Study Design-Term, nulliparous women requiring oxytocin doses of ≤4 milliunits/minute (low-dose requiring, n=83) or ≥20 milliunits/minute (high-dose requiring, n=104) for labor augmentation or induction were consented to a post-partum blood draw as a source of genomic DNA. Targeted-amplicon sequencing (coverage > 30X) with Illumina MiSeq was performed to discover variants in the coding exons of the oxytocin receptor gene. Baseline relevant clinical history, outcomes, demographics, and oxytocin receptor gene sequence variants and their allele frequencies were compared between low-dose-requiring and high-dose-requiring women. The Scale-Invariant Feature Transform algorithm was used to predict the effect of variants on oxytocin receptor function. Fisher's exact or chi-squared tests were used for categorical variables, and
Background-In 2010 the Consortium on Safe Labor published labor curves. It was proposed that the rate of cesarean delivery (CD) could be lowered by avoiding the diagnosis of arrest of dilation before 6 cm. However, there is little information on the uptake of the guidelines and on changes in CD rates that may have occurred.Objective-To test the hypotheses that: 1) among patients laboring at term, rates of arrest of dilation disorders have decreased leading to a decrease in the rate of CD; 2) in the second stage, pushing duration prior to diagnosis of arrest of descent has increased also leading to reduction in the rate of CD for this indication. As a secondary aim, we investigated changes in maternal and neonatal morbidity.Study Design-This was a secondary analysis of a prospective cohort study of all patients presenting at ≥ 37 weeks' gestation from 2010-2014 with a non-anomalous vertex singleton and no prior history of CD. Rates of CD, arrest of dilation, and changes in rates of maternal and neonatal morbidity were calculated in crude and adjusted models. Cervical dilation at diagnosis of arrest of dilation, time spent at the maximal dilation prior to diagnosis of arrest of dilation, and time in the second stage prior to diagnosis of arrest of descent were compared over the study period.Results-There were 7845 eligible patients. The CD rate in 2010 was 15.8% and in 2014 17.7% (p-trend 0.51). In patients undergoing CD for arrest of dilation, the median cervical dilation at the time of CD was at 5.5 cm in 2010 and 6.0 cm in 2014 (p-trend 0.94). In these patients, there was an increase in the time spent at last dilation: 3.8h in 2010 to 5.2h in 2014 (p-trend 0.02). There was no change in the frequency of patients diagnosed with arrest of dilation at <6 cm: 51.4% in 2010 and 48.6% in 2014 (p-trend 0.56). However, in these patients, the median time spent at the last
Three-dimensional power Doppler measurement of cerebral blood flow, but not the vascularization pattern, is significantly altered in FGR. This measurement may play a future role in distinguishing pathologic FGR from constitutionally small growth.
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