In this animal model, administration of myogenic stem cells to transected/repaired anal sphincters did not alter the amount of inflammation nor the volume of striated muscle, suggesting that stem cells might improve contractile function through other cellular processes.
The use of staples compared with subcuticular suture for cesarean skin closure is associated with increased wound morbidity. While this is true for non-diabetics, further studies of diabetics are needed to evaluate for a null or opposite effect of closure type.
BMI and oxytocin dosage are associated with select maternal and neonatal outcomes. However, the lack of interaction between BMI and oxytocin product suggests that the higher administered dose of oxytocin associated with increasing BMI does not synergistically potentiate maternal and neonatal morbidities.
A prolonged second stage of labor has been associated with increased maternal risk for complications such as puerperal infection, perineal lacerations, and postpartum hemorrhage. It is also associated with neonatal morbidities including admission to the intensive care unit, sepsis, and low Apgar scores. However, ending the second stage of labor based solely on its duration might not be necessary, according to existing research. This retrospective cohort study examined the changes that have occurred over the past decade in both the modes of delivery and the delivery outcomes for women who have not previously given birth.Women in their first pregnancies cared for by the obstetric service at the University of Alabama between January 1, 2011 and December 31, 2012 were included in the study if they reached full cervical dilation and were at 36 weeks gestation or greater. These women were compared with a prior cohort of patients from July 28, 2000, to February 28, 2003. Patients were excluded from the study if the fetus was prenatally diagnosed with anomalies. The 1476 mother and neonate pairs included in the current cohort had a higher rate of cesarean delivery than the 1023 pairs in the older cohort (6% vs. 2%). The current group also had a higher rate of spontaneous vaginal delivery (84% vs. 77%). However, they were less likely to undergo operative vaginal delivery compared to the older cohort (10% vs. 21%). For operative vaginal deliveries, the use of vacum increased from 45% to 75% and the use of forceps decreased from 55% to 25%. Patients from the current cohort had an adjusted odds ratio of cesarean delivery compared with any vaginal birth of 1.74 (95% confidence interval, 1.04-2.91) compared with the older cohort. A separate regression model was used to find the adjusted odds ratio of operative vaginal delivery as compared with spontaneous vaginal delivery or cesarean delivery, which was 0.42 (95% confidence interval, 0.33-0.54) for the current versus prior cohort. The median duration of the second stage of labor increased from 38 to 42 minutes, but there was no significant difference after adjusting for confounding factors. There was also no significant difference in maternal infection rate or umbilical artery pH between the 2 cohorts, though current patients had a higher rate of composite neonatal morbidity.Although the duration of the second stage of labor has not changed considerably from 2000 to 2011, women in their first pregnancies are now twice as likely to undergo cesarean delivery and half as likely to undergo operative vaginal delivery. This study therefore demonstrates the distinct change in the way the second stage of labor is being managed. This raises possible concerns, given the increased risk associated with a prior cesarean delivery. The reasons for these changes are unclear and have not led to improved outcomes for mother or child.
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