American Journal of Obstetrics and Gynecology

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Healthcare professionals working in labor wards worldwide regularly deal with the pressure of managing an emotionally charged and life-changing period for women, their families, and their friends. Furthermore, they frequently deal with long working hours, sleep deprivation, occasional scrutiny from the press, and legal dispute. The existing disagreements among leading scientific institutions on basic concepts of intrapartum care hinder the creation of a collective mental model in the labor ward, an aspect that is required for consistency in patient counseling and effective teamwork...

BACKGROUND: The clinical implications of non-reportable cfDNA screening results are uncertain, but this may reflect poor placental implantation in some cases and be associated with adverse obstetrical and perinatal outcomes. OBJECTIVE: To assess the outcomes of pregnancies with non-reportable cell-free DNA (cfDNA) screening in a cohort of patients with complete genetic and obstetric outcomes. STUDY DESIGN: This was a prespecified secondary analysis of a multicenter prospective observational study of prenatal cfDNA screening for fetal aneuploidy and 22q11...

BACKGROUND: Placenta Accreta Spectrum (PAS) disorders are a continuum of placental pathologies with significant maternal morbidity and mortality. Morbidity is related to the overall degree of placental adherence, thus patients with placenta increta or percreta represent a high-risk category of patients. Hemorrhage and transfusion of blood products represent 90% of PAS morbidity. Both tranexamic acid (TXA) and uterine artery embolization (UAE) independently decrease obstetric hemorrhage...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

Characterizing a labor pain-related neural signature is a key prerequisite for devising optimized pharmacologic and nonpharmacologic labor pain relief methods. The aim of this study was to describe the neural basis of labor pain and to provide a brief summary of how epidural anesthesia may affect pain-related neuronal activity during labor. Possible future directions are also highlighted. By taking advantage of functional magnetic resonance imaging, brain activation maps and functional neural networks of women during labor that have been recently characterized were compared between pregnant women who received epidural anesthesia and those who did not...

BACKGROUND: The second stage of labor requires active patient engagement. Prior studies suggest that coaching can influence second stage duration. However, a standardized education tool has not been established and patients face many barriers to accessing childbirth education before delivery OBJECTIVE: We investigated the effect of an intrapartum video pushing education tool on second stage duration. STUDY DESIGN: This was a randomized controlled trial of nulliparous patients with singleton pregnancies ≥37 weeks admitted for induction or spontaneous labor with neuraxial anesthesia...

Pregnant Muslim women may be religiously exempt from fasting during the Islamic month of Ramadan, especially if there is concern for undue hardship or harm to maternal or fetal health. However, several studies demonstrate that most women still choose to fast during pregnancy and avoid discussing fasting with their providers. A targeted literature review of published studies on fasting during Ramadan and pregnancy/maternal and fetal outcomes was performed. We generally found little to no clinically significant effect of fasting on neonatal birthweight or preterm delivery...

Fetal acidemia is a common final pathway to fetal death, and in many cases, to fetal central nervous system injury. However, certain fetal pathophysiological processes are associated with significant category II or category III fetal heart rate changes before the development of or in the absence of fetal acidemia. The most frequent of these processes include fetal infection and/or inflammation, anemia, fetal congenital heart disease, and fetal central nervous system injury. In the presence of significant category II or category III fetal heart rate patterns, clinicians should consider the possibility of the aforementioned fetal processes depending on the clinical circumstances...

Birthing balls and peanut balls have been used for decades by nurses and midwives as a nonpharmacologic adjunct to labor management based on anecdotal evidence. This article aimed to review the evidence regarding their safety and efficacy based on randomized controlled trials. Birthing balls are round exercise balls that a laboring individual can use for sitting, rocking, and pelvic rotation. The use of the birthing balls has been thought to increase maternal comfort and mimic upright positioning to widen the pelvic outlet for those laboring without an epidural...

BACKGROUND: The increased maternal cardio-cerebro-vascular risk after hypertensive disorders of pregnancy (HDP) is well documented in the literature. Recent evidence has suggested a shorter time frame for the development of these postnatal outcomes, which could have major clinical implications. OBJECTIVE(S): To determine the risk of and time to onset of maternal cardiovascular and cerebrovascular outcomes (CVO) after hypertensive disorder of pregnancy (HDP). STUDY DESIGN: We included 2,227,711 women, without pre-existing chronic hypertension, who delivered during the period 2008-2010: 37,043 were diagnosed with pre-eclampsia (PE:1...

BACKGROUND: Women with a history of hypertensive disorders of pregnancy (HDP) are at increased risk of cardiovascular diseases that are usually mediated by the development of cardiovascular risk factors, such as chronic hypertension, metabolic syndrome or subclinical myocardial dysfunction. Increasing evidence has been showing that little time elapses between the end of pregnancy and the development of these cardiovascular risk factors. OBJECTIVES: To assess the persistence of hypertension and myocardial dysfunction at four months postpartum in a cohort of women with HDP and to compare the echocardiographic parameters between the peripartum and the postpartum period...

BACKGROUND: Postmenstrual spotting and chronic pelvic pain after cesarean delivery (CD) are associated with the presence of niches. Levonorgestrel intrauterine system (LNG-IUS 52 mg) and hysteroscopic niche resection have been shown to relieve niche-related symptoms six months after the intervention. OBJECTIVE: This trial aimed to compare the effectiveness of LNG-IUS 52 mg with hysteroscopic niche resection in reducing niche-related postmenstrual spotting. STUDY DESIGN: This randomized, open-label, controlled trial was conducted at a medical center in Shanghai, China...

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.

No abstract text is available yet for this article.