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Standard (non-antimetabolite) combination chemotherapy administered past the first trimester, as early as 13 weeks gestation, was associated with few complications and expected maternal survival with lymphoma occurring during pregnancy.

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This decision analysis suggests that for women with a vasa previa, delivery at 34-35 weeks of gestation may balance the risk of perinatal death with the risks of infant mortality, respiratory distress syndrome, mental retardation, and cerebral palsy related to prematurity. At any given gestational age, incorporating amniocentesis for verification of fetal lung maturity does not improve outcomes.

I ntrapartum fetal monitoring, most commonly continuous electronic fetal heart rate by cardiotocography, was developed to prevent adverse perinatal outcomes associated with fetal asphyxia. Cardiotocography has reduced rates of neonatal seizures, but not perinatal mortality, and has increased operative delivery rates due to its poor sensitivity in predicting fetal compromise. Sensitivity can be enhanced significantly by using fetal blood sampling (FBS), which directly measures fetal capillary pH, base excess, or lactate. This monitoring technique reduces the rate of emergency cesarean section (CS) for nonreassuring fetal status. It is an invasive procedure, however, that has undesirable effects, that is, maternal discomfort, fetal scalp abscess, hemorrhage, and a failure rate of 11% to 20%. The technical difficulties and relatively small risk, however, can be justified by the reduction in CS rates. The authors of this retrospective study analyzed a group of consecutive parturients who had FBS to determine whether the rate of CS was increased in those undergoing sampling in early labor (r3 cm dilation) compared with those having it during established labor (Z4 cm dilation). The study also examined whether repeated FBS was associated with poorer neonatal outcomes.The study took place in 1 secondary and 1 tertiary obstetric unit in Manchester, England, between March 2008 and June 2009. Data were obtained from case notes and medical records for 381 women undergoing FBS. Logistic regression analysis was used to adjust for confounding variables. The median age of women studied was 27 years; mean body mass index was 25.6. The majority (67.4%) of patients were nulliparous, and the ethnicity distribution was representative of the general delivery population in the units participating in the study. Overall, 123 women (32.4%) had spontaneous vaginal deliveries; 118 (31%) had CS; and 140 (36.7%) had instrumental vaginal deliveries. Thirty-three (8.7%) women had a first FBS at r3 cm (early-labor group), whereas 348 (91.3%) had progressed to Z4 cm (later-labor group) at the time of FBS; 147 (38.6%) required 2 or more samplings. Of the early-labor group, 48.4% had instrumental or spontaneous vaginal delivery, compared with 71.9% of the established-labor group. The odds ratio (OR) of the early-labor group for CS was 2.62 [95% confidence interval (CI), 1.28-5.40], versus the established-labor group, although this OR dropped to 1.8 (95% CI, 1.04-3.13) after adjustment for factors that could affect the likelihood of CS (eg, parity, previous CS, body mass index, induction/augmentation, and maternal age). In women requiring Z2 FBSs, the OR for CS was 1.71 (95% CI, 1.37-2.13) compared with women requiring only a single sample. All babies were liveborn, with a mean birth weight of 3360 g. There were no significant differences in neonatal outcomes (umbilical artery pH, Apgar scores, neonatal intensive care unit admission) between infants whose mothers underwent FBS early versus later in labor. When Z3 samples were obtained during labor, ...

Objective To evaluate the length of the second stage of labor in relation to increasing maternal prepregnancy BMI among nulliparous parturients, and to determine whether route of delivery differs among obese, overweight, and normal weight women reaching the second stage. Methods We performed a secondary analysis of a multicenter trial of fetal pulse oximetry, conducted among 5,341 nulliparas who were induced or labored spontaneously at 36 weeks or more of gestation. Normal weight was defined as BMI of 18.5-24.9 kg/m2, overweight was a BMI of 25.0-29.9 kg/m2, and obese was a BMI of 30 kg/m2 or higher. Results Of the 5,341 women, 97% had prepregnancy BMI recorded. Of these, 3,739 had a BMI 18.5 kg/m2 or higher and reached the second stage of labor. Increasing maternal BMI was not associated with second stage duration: normal weight 1.1 hr, overweight 1.1 hr, and obese 1.0 hr (p=0.13) . Among women who reached the second stage, as BMI increased, so did the likelihood that the woman had undergone induction of labor. Even so, the lack of association between second-stage duration and BMI did not vary by method of labor onset (p=0.84). The rate of cesarean delivery in the second stage did not differ by increasing BMI: normal weight 7.1%, overweight 9.6%, obese 6.9% (p=0.17). Conclusion Among nulliparous women who reach the second stage of labor, increasing maternal BMI is not associated with a longer second stage or an increased risk for cesarean delivery.